Maine doctors received more than $4M from drug, device makers in 2013

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Maine doctors received more than $4 million from drug and medical device makers during the latter part of 2013, according to a new federal database that spotlights physicians’ ties with the health care industry.

The searchable database includes $3.5 billion worth of legal — but often controversial — payments to doctors and teaching hospitals by all pharmaceutical and medical device manufacturers in the country. The Open Payments program, created under the 2010 Affordable Care Act, lists compensation for consulting, travel, meals, promotional speaking and other gifts made from August to December 2013. Payments to doctors, dentists, podiatrists, optometrists and chiropractors must be disclosed.

The data includes payments to 560,000 physicians from across the nation. Experts warned the information is incomplete, covering just five months of last year and omitting many records.

The Maine records include $1,420,921 in general payments and $2,746,036 in payments specifically for research. All payments amounting to more than $10 must be reported, so the data included everything from lunches to major grants for clinical drug trials.

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In publicly releasing the information on 4.4 million payments, the U.S. Centers for Medicare and Medicaid Services aims to discourage overly cozy relationships that could lead to flawed medicine. The agency also seeks to help patients learn if their doctors receive money from companies whose products they prescribe.

“CMS is committed to transparency, and this is an opportunity for the public to learn about the relationships among health care providers, and pharmaceutical and device companies,” CMS Administrator Marilyn Tavenner said in a news release.

Financial ties between doctors and the medical industry do not necessarily indicate wrongdoing. The payments can fund research that leads to the development of life-saving medications and technology. They are also common, with 94 percent of U.S. physicians reporting ties with the industry, according to a 2007 study in the New England Journal of Medicine.

More recent data show such payments falling steeply since the Sunshine Act provision of the health reform law, which that called for the data’s release, passed four years ago.

But studies have also shown that such financial relationships can negatively affect how doctors prescribe medication and treatment. Deceptively marketed drugs have put millions of Americans at risk for infections, complications and even death.

Health advocates hailed the release of the data trove as a win for transparency, while doctors groups and medical societies argued the information was incomplete, potentially erroneous and misleading to patients.

CMS withheld a third of the database records due to concerns about the integrity of the information. The American Medical Association, along with many other health advocacy groups, asked the federal government to delay the launch of the database by six months in order to further review the data. CMS granted a 12-day extension.

The doctors group supported the Sunshine Act, but said “publishing inaccurate data leads to misinterpretations, harms reputations and undermines the trust that patients have in their physicians.”

“Today’s an important day to see whether they can put [the information] in a database that makes sense to people and if it’s really helpful information,” said Gordon Smith of the Maine Medical Association. “Or whether it will confuse people and, without putting it into context, will actually point the finger at physicians who are doing nothing wrong.”

While abuses have occurred in the past, medical and pharmaceutical ethics codes now make clear that doctors can’t accept certain payments, such as expensive meals or trips, he said.

The data released Tuesday reflects only five months’ worth of payments. Future reports detailing a full 12 months of payment data will be published each year, beginning in June 2015.

CMS officials said 40 percent of the information that was released was redacted to hide physicians’ names because officials couldn’t verify their information.

The Maine data names about 850 physicians.

With many physicians omitted from the data and others unnamed, experts cautioned against drawing too many conclusions about those who were identified.

Dr. Christine Lu-Emerson was taken aback Tuesday to learn that her name was attached to the single largest payment in Maine — totaling nearly $320,000. The data indicated she was paid by the drug company Merck for a clinical trial on a chemotherapy drug at the Maine Medical Center research facility in Scarborough where she works.

Lu-Emerson said she never led such a trial or received any money from Merck. The database also shows a second payment from the drug maker to her totaling nearly $84,000.

“If the money was paid out, I didn’t see a cent of it,” she said.

While the new database sheds light on doctors’ financial relationships with industry, it only “nibbles around the edges” of the broader effort to make health care better and more affordable, said Nancy Morris of the Maine Health Management Coalition.

“Our costs aren’t going to go down overnight because we have this information,” she said. “It’s just a piece of it; we need a lot more transparency.”

Tuesday’s federal data release comes more than a decade after Maine passed a state law requiring disclosure of such payments to doctors. Maine was among the first states to pass a “sunshine law,” enacting the legislation in 2003.

But the information was never entered into a publicly accessible database, Smith said. Then in 2011, Republican lawmakers led a successful effort to repeal the law, anticipating similar requirements on the way under the ACA, he said.

“We never really did get our law off the ground,” Smith said. “There were delays and questions.”

2012 study examining Maine’s law raised doubts about whether such sunshine laws actually affect physicians’ behavior. Published in the Journal of the American Medical Association, the study looked at sunshine laws in Maine and West Virginia to gauge their effect on doctors’ prescribing of drugs for high cholesterol and mood disorders.

Researchers found that doctors continued to prescribe the widely marketed brand-name medications even though generic versions were available. The effect of the laws in both states was negligible.

Unlike under the federal law, however, the information wasn’t publicly disclosed.

Several major pharmaceutical companies already report payments to physicians as a result of legal settlements over their marketing of some drugs.

What you need to know about the database

Planning to look up payments drug and medical device companies made to your doctor? Be aware of the information’s shortcomings first.

The data’s missing a lot of payments. It covers payments made over only for five months, from August to December 2013. If your doctor received compensation in say, February of last year, that won’t show up. The federal government says future data will be more complete, with information for all 12 months of this year expected next summer.

The federal Centers for Medicare and Medicaid Services also said that a third of the payment records companies submitted wouldn’t be released immediately, after concerns about the data’s integrity arose. In investigating one doctor’s complaint, CMS discovered many physicians were assigned erroneous identification numbers. The problems forced the agency to delay the database’s publication.

Some payments were intentionally excluded. Physicians, dentists, podiatrists, chiropractors and optometrists are covered. But drug and medical technology companies don’t have to report payments to other health professionals under the law, such as nurse practitioners.

Companies can also hold off on publicly releasing payments related to research for new products until after gaining FDA approval or four years after the payment was made, whichever comes first, according to a report by ProPublica.

A wide variety of compensation is included. The database includes everything from fees for speaking at events to research grants and entertainment and meals. As ProPublica pointed out, different types of payments indicate varying levels of involvement with a company.

The database has errors. This marks the first time CMS has released this data, so some problems are expected. Drug and medical device manufacturers may make mistakes in submitting the data, and the American Medical Association has said the 45-day window physicians were given to review and dispute payments before Tuesday’s release was insufficient and confusing. Of the nearly 550,000 physicians affected by mandate, only 26,000 were able to register to review their data and pursue corrections for any inaccuracies.

Other sources of information are available. Also check out ProPublica’sDollars for Docs tool, which has tracked similar information since 2009.

 — Jackie Farwell, Bangor Daily News

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