Pharma companies that make payments to doctors--and the doctors who receive those payments--have repeatedly insisted there's no link between those payments and prescriptions. But data on Medicare's top script writers may have them answering for it all over again.
Nearly one-fourth of Medicare's 400 most prolific prescribers in 2013--those who prescribe at least $1 million worth of meds in the Medicare Part D program--pocketed consulting fees or other financial perks from the makers of those very drugs, according to a Modern Healthcare analysis of Part D data and the Open Payments database.
And going down the list, the pattern holds true, Modern Healthcare found. About 20% of the 2,200 physicians who prescribe at least $500,000 worth of a single drug received money from that med's manufacturer, and about 17% of the nearly 36,000 providers who prescribed $100,000 or more of a single treatment did the same.
|Cleveland Clinic's Steven Nissen|
To those who believe payments influence docs' prescribing habits, it's a red flag. "It is frankly magical thinking to believe that those two things are not related," Eric Campbell, a Harvard Medical School sociologist who studies conflicts of interest in healthcare, told the publication, calling it "completely not in the realm of reality" to deny a relationship between the two. Outspoken cardiovascular chair of the Cleveland Clinic, Dr. Steven Nissen, dubbed it "an enormous problem."
The Centers for Medicare & Medicaid Services (CMS), though, cautioned that pharma-to-doc payments don't always spell a conflict of interest, pointing out in a statement to MH that it has a "range of tools" in place to track bad behavior and fishy prescribing patterns.
"Information about financial relationships alone is not enough to decide whether they're beneficial or improper," it said. "Just because there are financial ties doesn't mean that anyone is doing anything wrong. Transparency will shed light on the nature and extent of these financial relationships and will hopefully discourage the development of inappropriate relationships."
That was the thinking behind the Physician Payments Sunshine Act, which last year began requiring companies and healthcare providers to come clean about what kinds of perks were changing hands.
Pharma, though, hasn't been too thrilled to have its records go public--and neither have some doctors, who claim they've landed at the top of the highest-paid list unfairly.
"If the only information conveyed to the public and media regarding transfers of value between manufacturers and physicians involves dollar amounts--without a full, adequate explanation of the benefits generated for the public as a result of those interactions--there are legitimate concerns on the part of physicians that they will be unfairly stigmatized and lose the faith and confidence of their patients and the public at large," the Healthcare Leadership Council's president, Mary Grealy, said during congressional hearings last summer.
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