Medical firms paid billions to health-care providers

WASHINGTON -- From research grants to travel junkets, drug and medical device companies paid doctors and leading hospitals billions of dollars last year, the government disclosed Tuesday in a new effort to spotlight potential ethical conflicts in medicine.

Industry spent nearly $3.5 billion on such payments in the five-month period from August through December of last year, according to the Centers for Medicare and Medicaid Services, which released data on 4.4 million payments.

The massive trove of information named companies and many of the recipients, although in about 40 percent of the records, identifying details were removed because of unresolved questions. Also listed were types of payments, with details down to travel destinations. Some 546,000 clinicians and 1,360 teaching hospitals received payments. Some also had ownership stakes in companies.

It's all part of a new initiative called Open Payments, mandated by President Barack Obama's health care law. As conceived, Open Payments was intended to allow patients to look up their own doctors online, but that functionality isn't fully ready. In future years, the information will cover a full 12 months and will be easier to search, officials said.

Still, the preliminary data are expected to be useful for professional researchers. About 300,000 records are still being verified, and were not included, so the total value of payments is expected to be higher.

Consumer groups applauded the move as a much-needed step toward greater transparency. But doctors and industry said the government rushed to release the data, and raised questions about accuracy and lack of context.

Obama's administration has seen a policy shift to open the books of the medical profession. Unlike his health care law, Open Payments is supported by members of both political parties. A few months ago Medicare released its huge claims database, showing program payments to more than 825,000 providers for 2012.

Drug companies traditionally have prized their relationships with doctors, the gatekeepers between patients and prescription medications. But consumer groups see a conflict of interest that could influence prescribing decisions.

Some doctors' offices have started curbing pharmaceutical marketing, which can include anything from free pens and pizzas to paid speaking engagements and golf outings at fancy resorts. But many doctors also receive significant payments to help drug companies conduct clinical research.

The American Medical Association says it is "extremely concerned" about release of the payments file, adding the data may contain inaccuracies and lacks context to help the average person evaluate the information. The federal Centers for Medicare and Medicaid Services provided individual doctors an opportunity to inspect their data before release, but the AMA says the window was short and the process cumbersome.

Consumer groups call the disclosure program the "Sunshine Act," and say it's overdue.

"Research has shown over and over that these financial relationships influence doctors, even a meal," said John Santa, medical director for health projects with Consumers Union. "Studies also show that doctors believe it does not affect them, but strongly believe it affects other doctors."

AMA President Robert Wah said some financial dealings between doctors and the drug industry help patients, particularly when it comes to research. There are "appropriate relationships in this realm that can help drive innovation in patient care," Wah said.

The information being released Tuesday covers payments by drug and medical device manufacturers to doctors and teaching hospitals.

Also to be reported are certain ownership stakes.

The program covers doctors, dentists, podiatrists, optometrists and chiropractors. The health-care law requires manufacturers to report payments and gifts unless they are valued at under $10.

The disclosure provision was championed in Congress by Sen. Charles Grassley, R-Iowa, who said Monday he hopes the data will become a resource for consumers over time.

"The patient who is prescribed a drug that might be beneficial yet risky will be able to learn whether the prescribing doctor accepted drug company money to study the risks," Grassley said in a statement. "The information might not change the outcome, but it's something a patient might like to know."

Others worry it will discourage doctors from participating in research sponsored by drug companies.

"My biggest concern is it will have a chilling effect and physicians will say `I don't want to see my name on a list,"' said Mary Grealy, president of the Healthcare Leadership Council, an umbrella group that includes doctors, hospitals and drug companies. She would like to see the $10 reporting threshold increased, and more context on payments for research.