Government data released on June 30, covering a 17-month period between August 2013 to December 2014, revealed drug companies and medical device manufacturers paid out approximately $3.5 billion to physicians and medical training programs for promotional talks, research and consulting. A total of 1,617 companies reported 15.7 million payments valued at $9.9 billion. Nearly all of those payments — 14.9 million — were classified as “general payments,” covering promotional speaking, consulting, meals, travel and royalties. They totaled $3.5 billion over the 17-month period.
The information is public as a result of a provision of the Affordable Care Act (ACA) known as the Sunshine Law that requires the health care industry to release details of its payment to doctors and teaching hospitals. The transparency process is called Open Payments. Companies must also provide information on the value of non-monetary “perks,” such as gourmet meals, trips and other “entertainment.”
An informational website operated by the Centers for Medicare & Medicaid Services at CMS.gov provides a searchable database for this type of information. Open Payments does not include money spent on drug samples left at doctors’ offices. Interestingly, the tally also doesn’t include the bulk of the money companies spend on independently administered continuing medical education, which they support with unrestricted grants. The government has tightened the rules for reporting such continuing education in the future.
ProPublica, an independent, non-profit newsroom that produces investigative journalism in the public interest, also created an online search tool it calls “Dollars for Docs,” that allows users to search for general payments in a certain reporting period. The search excludes research and ownership interests. Users can search by a doctor’s name and/or state, and by company to see how payments break down by drug, device or doctor.
The drug and device companies insist the payments are about funding and encouraging research and education. I concede that some of them undoubtedly are. Physicians regularly consult with drug makers and medical device manufacturers on how these products are working for patients. Health care professionals are also involved in clinical trials, and should be compensated for their time and expertise.
But the drug and medical device industry’s practice of paying “kickbacks” to physicians has become endemic in recent years. For example, in 2007, three major manufacturers of metal-on-metal hip replacements were targeted in a Department of Justice investigation sparked by reports that the prosthetic devices were defective and subject to premature failure – and that the manufacturers were aware of these defects. In the wake of this investigation, the U.S. Department of Health and Human Services reported that these companies had paid out $800 million over a four year period to “physician consultants” who promoted the devices as safe and effective.
Of course, a payment from a health care products maker to a physician in of itself – standing alone – is not necessarily a bribe or a kickback. Many of these payments may indeed be for legitimate services. However, independent analysts point out that such payments from industry are very likely to influence a physician’s choice of drugs and devices, and opinions on those products. If the drug manufacturers cross the line – and doctors are in fact compromised – that’s a horse of a different color. That is why transparency is so very important. Now, thanks to the Sunshine Provision of the ACA we can at least see who is paying how much to whom and get some idea of why these payments are being made.
Sources: www.ringoffireradio.com, ProPublica, NPR
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