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November 23, 2010

Physician Payment Sunshine: Massachusetts Releases 2009 Provider Payments

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The Massachusetts Office of Health and Human Services (EOHHS), published the last ½ of 2009 data on industry payments from pharmaceutical and device companies to physicians and health care providers, in accordance with the Pharmaceutical and Medical Device Manufacturer Code of Conduct (PCOC). The Department, as required by legislation, has created a database to provide the disclosed payment information to the public.

The data is contained in a large spreadsheet. The sheet appears to be organized by manufacturer or company. Then there are specific reports prepared by EOHHS, as described below.

The top recipient of funds was the Boston Healthcare Homeless Project which received $2,000,000 to help homeless patients.  The second was the Joslin Clinic was $1.3 million for continuing medical education grants, to help physicians understand how to better treat diabetes.

For example, EOHHS has provided summaries of the information such as the Top 20 manufacturers who paid physicians and hospitals in 2009 for research and education. There is a more detailed summary of the exact entities (i.e. hospitals) and providers for each specific company as well.

The mix of companies in the top five include:  Boston Scientific ($2,542,165), Eli Lilly ($1,726,503), Ethicon Endo Surgery ($1,641,694), Genzyme ($1,413,250) and Pfizer ($1,337,707).   Medical device manufactures, paid larger payments to few physicians (mostly royalty payments for inventions) Pharmaceutical companies paid smaller payments to thousands of physicians (speaking and consulting).

The report then gives a breakdown of the top 50 paid physicians, and detailed report of what services the physicians provided and which companies made such payments. On the spreadsheet, the number of payments made is listed, the number of events, as well as the total amount of compensation a physician received. The physician’s license number is also published. The detailed reports go into what category the payment was for, the specific amount of payment, and which specific company.

The website includes detailed instructions on how to create custom reports and how to run searches for doctors, manufacturers, and by payment category, which includes eight categories of payments to covered recipients (CRs):

  • Compensation for Bona Fide Services (i.e. consulting, Speaker’s Bureaus, etc.)
  • CMEs, Third-party Conferences, or Meetings
  • Grants/Educational Gifts
  • Food
  • Education/Training
  • Marketing Studies
  • Charitable Donation (donations other than donations of prescription drugs, biologics, or devices)
  • Other (non-exempt payments to CRs of $50 or more)

The website also allows the public to search for payments to acute care hospitals, and includes a detailed report of such payments as well. For hospitals, the spreadsheet only details the number of companies who made payments to the hospital, the number of events, and the total amount of compensation. The detailed report provides the specific payment category, company, and amount per activity.

There is also a list of the top 100 recipients with the highest totals (excluding hospitals and hospital satellites), based on the data reported, as well as a detailed summary of each recipient. These spread sheets provide the same information above and just combine them.

Background of PCOC

The PCOC requires manufacturers of pharmaceuticals and medical devices to disclose certain transactions (any fee, payment, subsidy or other economic benefit with a value of at least $50) with anyone who prescribes, dispenses or purchases prescription drugs or medical devices in the Commonwealth. This does not include consumers who purchase prescription drugs or medical devices. 

The companies must disclose “the value, nature, purpose and particular recipient of any fee, payment, subsidy or other economic benefit with a value of at least $50 to any covered recipient in connection with the company’s sales and marketing activities” (105 CMR 970.009(1)). This includes:

  • Reimbursement of expenses in conjunction with a product training program or event,
  • Compensation for serving as faculty at a Continuing Medical Education (CME) event or participation on a Speaker’s Bureau, and
  • Compensation for bona fide services.

The website explains that any of these transactions may be referred to as “payments.” The $50 total is for each occurrence, not in total for the year. For example, a $55 dinner provided to a covered recipient would have to be reported, but two $30 dinners would not, even though added together, they total more than $50. The EOHHS explains more about PCOC on their website.

The code applies to pharmaceutical and medical device manufacturers that employ or contract with any person to sell or market prescription drugs or medical devices in Massachusetts.

The PCOC also prohibits by law certain gifts and payments.

Impact of Data

When the bill was passed in the legislature it was presented that this was to help patients understand their physician’s relationships with industry.

This data is basically useless to patients as one needs advanced computer skills just to find the information.   One needs to have excel to access the list.   In one section to make a “custom report” includes 15 pages of instructions.  It is doubtful that any “patient” would waste their time going through those 15 pages.

By the way the data is presented with top 100 lists….it is designed for impressing the media and provide the basis for research by anti industry groups to help write more stories for the media in an endless and useless cycle.    

It is also clear that the PCOC is hopeful that this data will be used for justification for more legislation.   

According to one physician listed in the top hundred many of the payments that were reported, were made to a healthcare provider’s facility and had little to no financial impact on the reported “recipient”.   

The report includes the cost for things such as clinical investigator travel, which though covered by a company these payments, are necessary to conduct clinical trials.

One company that had a total of less than 30 events (payments to physicians) revealed that they spent over $1,000,000 to comply with the law, given there are several hundred companies on the list it is not a far stretch to imagine that more funds were spent on compliance to this law than on the actual payments to healthcare providers.

What is not portrayed in all this “data” is the necessity of many of these payments is for research and development of new products.  The report shows the charitable side of manufactures in that the highest single recipient is Boston Homeless Healthcare Project.

In the coming weeks, media sources will likely use this data to create sensational headlines as we have seen in the case of ProPublica.   Journalists who decide to cover this story and report certain payments have a duty to the public to report fair and objective stories about physician-industry collaboration. This duty goes beyond just asking a doctor why they work with industry, or what role they play, and then quoting critics of industry.

Journalists need to find out the true value doctors are providing to patients and physicians by consulting for companies to discover new drugs or improve new treatments. Absent from many news stories is how numerous diseases have been prevented and treated because of industry. Vaccinations, largely manufactured and developed by industry, have improved public health significantly. Death rates have dropped and survival has increased for severe diseases such as cancer and heart disease. And chronic illnesses such as asthma and diabetes are now manageable. There is a high value in physician-industry collaboration.

Media sources must keep the public’s best interest in mind when covering these payments. There is over a decade of history involved with physician-industry collaboration, and millions of lives have been saved and made healthier because of this partnership. At a time when health care is on the forefront of American policy, when doctors are needed, patients are unhealthy, and our system is overcrowded, industry-physician collaboration is major resource for solving these problems. Now that this information is public, journalists have a duty to use it fairly.

The Physician Payment Sunshine Provision of the Affordable Care Act when implemented will pre-empt much of the Massachusetts report going forward as it pre-empts the reporting of payments to physicians but not to other healthcare providers including pharmacist’s nurses and psychologists.

The state house and Governor Fitzpatrick have both declared that they want to revise the current law, so we may see a change in 2011.

List of Website Links for MA Payments

Background of Massachusetts Pharmaceutical and Medical Device Manufacturer Code of Conduct or “Massachusetts Marketing Code of Conduct”

The Massachusetts Statute (PDF) | RTF

Department of Public Health regulation (105 CMR 970.000) | RTF

Public Health Council Memorandum (PDF)

Frequently Asked Questions (PDF) | RTF

Massachusetts Department of Health and Human Services

Information for Consumers

Basic terms, information and definitions.

Entire Data Set of Reported Payments

Types of Payment Categories Reported (i.e. CME, travel, food, etc.)

Manufacturers

Top 20 Manufacturers Summary (PDF) | Excel
This report shows summary payment amounts made by the top 20 pharmaceutical and medical device-manufacturing companies. It shows only the total amount reported.

Top 20 Manufacturers Detail (PDF 2.38MB) | Excel 1.65MB
This report shows the top 20 pharmaceutical and medical device manufacturing companies by payment amount made, with recipient and category detail.

Physicians

Top 50 Physicians Summary (PDF) | Excel
This report shows the total payment amounts for the 50 physicians with the highest totals, based on the data reported. It shows only the total amount reported.

Top 50 Physicians Detail (PDF) | Excel
This report shows the total payment amounts for the 50 physicians with the highest totals, based on the data reported. It shows the totals and then breaks out the detail by manufacturer and category of payment.

Hospitals

*Important note on hospital reports: One hospital may have many locations (campuses, satellites, clinical labs, etc.) that are related to the way they are licensed. These reports attempt to aggregate those locations.

Acute Care Hospitals Summary (PDF) | Excel
This report shows the total payment amounts for acute care hospitals based on the data reported. It shows only the total amount reported.

Acute Care Hospitals Detail (PDF) | Excel
This report shows the detail for the payments to acute care hospitals based on the data reported. It shows the totals and then breaks out the detail by manufacturer and category of payment.

Covered Recipients (Excluding Hospitals)

Top 100 Covered Recipients, Non Hospital, Summary (PDF) | Excel
This report shows the total payment amounts for the 100 recipients with the highest totals (excluding hospitals and hospital satellites), based on the data reported. It shows only the total amount reported.

Top 100 Covered Recipients, Non Hospital, Detail (PDF) | Excel
This report shows the total payment amounts for the 100 recipients with the highest totals (excluding hospitals and hospital satellites), based on the data reported. It shows the totals and then breaks out the detail by manufacturer and category of payment.

Custom Reports

This section offers specific instructions on how to look for payments in three ways.

Payments by Category

If you are looking for what types of payments a company made to any covered recipients (and the total dollar amount of those types of payments), search in Payments by Category.

Detailed Instructions (Word 1.19MB) 

Run Payments by Category Report

Payments Made by Manufacturer

If you are looking for all the payments a particular company made and to whom, i.e., which covered recipients (for example, doctors, hospitals, pharmacists), search in Payments Made by a Manufacturer.

Detailed Instructions (Word 2.5MB)

Run Payments by Manufacturer Report

Payments Made to a Recipient

If you are looking to see if a particular health care provider received any payments, search in Payments Made to a Recipient.

Detailed Instructions (Word 3.08MB)

Run Payments Made to Recipients Report

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