Month: June 2016

by Megan Hart, Dan Margolies, Heartland Health Monitor

Physicians associated with Kansas hospitals received about $7.4 million in payments from drug and medical device companies in 2014, with more than half going to providers in the Kansas City area.

A database compiled by ProPublica shows the companies paid about $4.1 million to physicians associated with hospitals in the Kansas City area and $1.7 million to those working with hospitals in the greater Wichita area.

It isn’t illegal for doctors to accept meals, speaking fees and other forms of compensation from drug and medical device companies, as long as they don’t receive kickbacks for prescribing certain medications or devices. Some studies have found, however, that doctors who accept payments tend to prescribe more expensive drugs more frequently than generics, at least in certain cases.

Doctors who received more payments were more likely to prescribe the expensive drugs than those who received smaller amounts, though that doesn’t prove the payments caused the prescribing or that doctors who received payments intentionally did anything differently.

In addition to being geographically concentrated, most of the money went to relatively few physicians. About $2.7 million, or more than a third of the money the industry spent on doctors in Kansas, went to the top 15 recipients — or 0.5 percent of the 2,852 doctors who received some form of payment.

Top 10 individual recipients of payments in Kansas
• Steven M. Simon, Shawnee Mission Medical Center, physical medicine and rehabilitation, $541,850
• Ivan Osorio, University of Kansas Hospital, Kansas City, neurology, $285,488
• James K. Brannon, Doctors Hospital, Leawood, orthopedic surgery, $243,767
• Andrew J. Green, Olathe Medical Center, endocrinology, $194,972
• Ryan Michael Taylor, University of Kansas Hospital, gastroenterology, $188,752
• James R. McAtee, Manhattan Surgical Hospital, orthopedic surgery, $179,287
• Zachary Seth Collins, University of Kansas Hospital, diagnostic radiology, $140,504
• David Michael Wichman, Wamego Health Center, psychiatry, $137,239
• Mark Camden Whitaker, Wesley Medical Center, Wichita, orthopedic surgery of the spine, $120,708
• Robert P. Cusick, Kansas Surgery and Recovery Center, Wichita, adult reconstructive orthopedic surgery, $117,777

See how Kansas compares to other states on the interactive ProPublica map. https://projects.propublica.org/graphics/d4d-hospital-lookup
For more information about the data sources for this story, see ProPublica’s How We Compiled the Dollars for Docs Hospital Data. https://www.propublica.org/article/how-we-compiled-the-dollars-for-docs-hospital-data

Out of 4,005 doctors affiliated with hospitals across Kansas, about 29 percent, or 1,154 doctors, didn’t receive any payments. Another 14 percent received less than $50 — in some cases, as little as $10 — and 8 percent received between $50 and $100.

Generally, the number of doctors receiving payments went down as amounts increased, though 14 received $100,000 or more from pharmaceutical companies.

While sorting doctors by the hospital where they work can be instructive, the hospital may not be directly affected by what doctors choose to accept. For example, Steven M. Simon, a physical medicine and rehabilitation specialist, received nearly $542,000 in industry payments — making him one of top recipients of industry money in the Kansas City area. But most of the money was related to his private practice, Mid-America Physiatrists in Overland Park, and not to his affiliation with Shawnee Mission Medical Center.

In a telephone interview, Simon said half or more of the money was reimbursement for expenses like air fare and hotels. He said he frequently lectures on medications to other providers, necessitating frequent travel.

“These are FDA-approved programs sponsored by the pharmaceutical company to familiarize physicians with product,” he said.

Similarly, David Michael Wichman, a Wamego psychiatrist who accepted $137,239 in payments, mostly for speaking, said he makes presentations at continuing education events on his own time and doesn’t consider it related to his affiliation with Wamego Health Center.

Wichman said most of his presentations are to physicians working in rural areas of Kansas and Nebraska. The presentations cover newer psychiatric medications, including antipsychotics and antidepressants, he said.

“A lot of it is going out and talking to family physicians that are struggling to treat psychiatric patients,” he said.

The Food and Drug Administration regulates what information can be included in presentations and requires the speaker to cover how the medication works, side effects and studies the FDA used when deciding whether to approve the drug, Wichman said. Half of the presentation can’t be about a specific drug but must include general information like how to manage bipolar disorder, for example, he said.

“You can only give that unbiased, this is what the drug is, this is what it does” information, he said.

Wichman said he had done some teaching since he was chief resident at University of Kansas Medical Center in 2008, and gradually began making presentations at continuing education events and events discussing pharmaceuticals. He said he supports publishing information about physicians’ finances and prescribing patterns but thinks concerns about pharmaceutical payments influencing physician behavior may be overblown.

Doctors who attend a presentation about a new drug typically are interested in what it could do for their patients, Wichman said. If that drug offers an advantage — such as reduced metabolic side effects from new antipsychotic drugs — patients benefit, he said.

Doctors “didn’t go to that many years of schooling to be ‘bought’ for a $20 meal,” he said.

The insurance system also limits doctors’ ability to get too eager about a new drug, Wichman said. Most insurers use a form of step therapy, so doctors have to show that their patients aren’t doing well on a cheaper generic before trying a more expensive brand-name drug, he said.

“A lot of these patients that are on the brand-name medications are patients that have failed on two or three non-branded generic medications,” he said.

The nonprofit KHI News Service is an editorially independent initiative of the Kansas Health Institute and a partner in the Heartland Health Monitor reporting collaboration. All stories and photos may be republished at no cost with proper attribution and a link back to KHI.org when a story is reposted online.

– See more at http://www.khi.org/news/article/kansas-doctors-received-7m-in-drug-company-payments-in-2014#sthash.p9tcqm59.dpuf

by Dan Margolies, Heartland Health Monitor

Kansas City-area hospitals vary greatly when it comes to the percentage of their doctors who accept money from drug and medical device companies.

The hospital with the highest percentage is Providence Medical Center, where nearly 89 percent of its doctors took such payments in 2014, the last year for which data are available. The hospital with the lowest percentage is Truman Medical Center Lakewood, where only 43.8 percent of its physicians took payments from those industries in 2014.

Much of the variation has to do with hospital policies governing such payments and how well they’re enforced. Truman, for example, has a policy that it adopted in 2004 spelling out when it’s appropriate to accept payments and limiting drug and medical device representatives’ interactions with hospital personnel.

“In a general way, we’ve said that people shouldn’t accept even the smallest of gifts unless there’s some legitimate work that one is doing on behalf of that pharmaceutical company,” said Dr. Mark T. Steele, chief medical officer and COO of Truman Medical Centers.

“We needed to make sure,” he said, “that we prevented any real or perceived undue influence by industry representatives.”

Elizabeth Nikels, a spokeswoman for Prime Healthcare, which owns Providence Medical Center, said the company requires its physicians to disclose any conflicts of interest in their initial and re-credentialing applications.”

“This includes disclosures of associations with pharmaceutical or other companies,” Nikels said in an email. “We discourage any relationships that may affect physicians’ ability to provide unbiased patient care while ensuring the highest standards of care at all our hospitals.”

Just because a hospital has a high percentage of doctors accepting payments doesn’t mean it has an in-depth relationship with the industry. In many cases, it may simply mean that more of its doctors accepted meals from companies.

But experts have discussed whether even relatively small payments, including meals, may influence doctors’ prescribing patterns.

A study published online this month in JAMA Internal Medicine looked at physicians who received meals tied to medications for high cholesterol, heart rhythm disorders, high blood pressure and depression. The study’s somewhat surprising conclusion: Even doctors who received just one meal from a drug company were more likely to prescribe that company’s more expensive brand-name drug than cheaper alternatives that are just as effective.

“Even beyond a meal, things as small as a pen or pad of paper can have some undue influence,” Steele said.

In some cases, hospitals boasting relatively low percentages of doctors who took industry payments also had some of the biggest recipients of industry money.

Only 56 percent of the University of Kansas Hospital’s physicians took industry payments in 2004, for example. But three of its doctors were among the Top 10 recipients in the Kansas City area of industry payments.

All members of KU Hospital’s medical staff must be members of the medical school faculty, which is part of the University of Kansas Medical Center.

Natalie Lutz, a spokeswoman for the medical center, said several policies and statutes cover drug company payments to clinical faculty. The medical center’s conflicts-of-interest policy requires its doctors to report all payments above $5,000, she said in an email. Employees are allowed to serve as consultants to the industry – and accept meals in their role as consultants – as long as they disclose any conflicts of interest.

“In addition,” she said, “meals are allowed if they are provided at events that are widely attended, such as a continuing medical education symposium.”

Steele, of Truman, said that the hospital’s status as an academic medical center – it’s the primary teaching hospital for UMKC Medical School – was a major factor in the enactment of its conflicts-of-interest policy.

More than a dozen years ago, Jerome Kassirer, a former editor of the New England Journal of Medicine and author of a book titled “On the Take: How Medicine’s Complicity with Big Business Can Endanger Your Health,” lectured Truman and UMKC doctors about how interactions with drug companies can influence prescribing patterns.

“He was pretty passionate,” Steele said. “And we had discussions at a high level and thought we should enact a pretty strict policy around this and agreed that people shouldn’t be taking little trinkets that the pharmaceutical representatives wanted to hand out or be going to dinner and things unless it was appropriate.”

The nonprofit KHI News Service is an editorially independent initiative of the Kansas Health Institute and a partner in the Heartland Health Monitor reporting collaboration. All stories and photos may be republished at no cost with proper attribution and a link back to KHI.org when a story is reposted online.

– See more at http://www.khi.org/news/article/area-hospitals-vary-in-percentage-of-doctors-who-take-drug-company-payments#sthash.asyCgWBm.dpuf