As we have covered numerous times on this blog, in 2009, the State of Massachusetts enacted the Massachusetts Pharmaceutical and Medical Device Manufacturer Code of Conduct (PCOC).
After going into effect on July 1, 2009, the PCOC requires the reporting of payments of more than $50 made to any health care practitioner by industry. Payments for 2009 were then published on the states website in late November, 2010. The legislation is very similar to the Physician Payment Sunshine Act.
We noted almost three months ago, back in December, that Massachusetts had not published its data for 2010, and was several weeks behind from 2010. Interestingly, we noted that if just one State is having difficulty posting payments on a public website and collecting payment data, what difficulties might the Centers for Medicare and Medicaid Services (CMS) have publishing payments for 50 states Sunshine Act.
Massachusetts published their data on December 27, 2011 and we waited to see when it would be reported Now, at the end of February, almost two months after the payments were finally posted, the Boston Globe actually decided to research the payments. For a policy that was supposed to promote transparency and give the public information, two month delay makes the payment data seem pretty unimportant, especially since the Globe is the only publication we found in Massachusetts to have even covered the payments (and they were two months late).
The payments, which were published in mid-December, includes a list of the:
- Top 20 Manufacturers Summary (2010), which includes 620 pages of payments.
- Top 100 Covered Recipients, Non Hospital, Detail
The Globe noted that the data includes $64 million in payments from hundreds of companies in 2010 for speaking, consulting, food, educational programs, marketing studies, and charitable donations. The largest portion of payments—$30 million—went to physicians. The Globe noted that comparisons with 2009 are difficult because payments for the previous year were only the second half of 2009. Nevertheless, they noted that “payments appear to have fallen,” given that they totaled $35 million for six months in 2009.
Part of the explanation for a drop in revenue is that “a number of hospitals, including Partners HealthCare, which oversees Massachusetts General and Brigham and Women’s, have placed strict limits on the work doctors can do for pharmaceutical and device companies. Partners prohibited its physicians from participating in promotional drug company speakers bureaus as of January 2010, out of concern that physicians could lose their objectivity.”
In 2010, Sanofi-Aventis US gave the most money, paying 427 recipients $4.7 million—around $11,000 on average. Most of that total went to the Joslin Clinic to develop books, brochures, and videos about managing diabetes for primary care doctors across the country and their patients, said Joslin Spokesman Jeffrey Bright. Clinic staff produced the materials for Sanofi-Aventis and then delivered it to the company to distribute, he said. Bright said the materials produced do not promote the company’s drugs. “We are very vigilant about that here,’’ he said.
These kind of educational patient materials clearly seem like the appropriate source of funding for a company to provide to a clinic.
Conclusion
Given the apparent complete lack of interest that Boston and the state of Massachusetts haven given these payments this year, three issues come to mind. First, the state has considered several times reversing the code of conduct, and this may be more fuel to that fire since the public and media clearly are not interested. Second, with the eventual roll out of the Sunshine Act, the Massachusetts law will likely be seen as duplicative, burdensome and unnecessary, and it is only a matter of time until the State scraps their reporting system. Third, all this data collection was done at tremendous costs to the companies providing the information. In the end will all the time and effort which could have been spent on the pursuit of finding cures be worth it?
Accordingly, with one of the first states to publicly post such payments taking a back seat, it will be interesting to see how many states do the same once the Sunshine database is up and running, which will likely not be until late 2013.
I don't think that the 2-month delay between the State report and the Globe pick up is that significant a point. The important point is how the Globe handles the data. The total dollar amounts received by physicians are (as you have pointed out in previous posts) subject to severe misinterpretation. The campaign to end this nonsense needs to focus on the benefits that result from physician Pharma interaction.
Posted by: Bill Glazer MD | March 08, 2012 at 10:34 AM