Industry Payments To Doctors Are Ingrained, Federal Data Show

Few days went by last year when New Hampshire nephrologist Ana Stankovic didn't receive a payment from a drug company.

All told, 29 different pharmaceutical companies paid her $594,363 in 2014, mostly for promotional speaking and consulting, but also for travel expenses and meals, according to data released Tuesday detailing payments by drug and device companies to U.S. doctors and teaching hospitals. (You can search for your doctor on ProPublica's updated Dollars for Docs interactive database.)

Stankovic's earnings were certainly high, ranking her about 250th among 606,000 doctors who received payments nationwide last year. What was more remarkable, though, was that she received payments on 242 different days —nearly every workday of last year.

Reached by telephone Tuesday, Stankovic declined to comment. On her LinkedIn page, Stankovic lists herself as vice chief of staff at Parkland Medical Center HCA Inc. in Derry, N.H., and as medical director of peritoneal dialysis at DaVita Inc., also in Derry.

That doctors receive big money from the pharmaceutical industry is no surprise. The latest data released by the Centers for Medicare and Medicaid Services shows that such interactions are widespread, with not only doctors, but thousands of dentists, optometrists, podiatrists and chiropractors receiving at least one industry payment from August 2013 to December 2014.

What is being seen for the first time now is how ingrained pharmaceutical companies and their sales reps are in the lives of those who write prescriptions for their products. A ProPublica analysis found that 768 doctors received payments on more than half of the days in 2014. More than 14,600 doctors received payments on at least 100 days in 2014.

Take Juichih Hsu, a Maryland doctor whose specialty is family medicine. She received payments on 286 days of 365, more than anyone else. Sometimes, she received meals from several drug companies on the same day. Hsu's payments totaled $5,959. She declined to comment when reached on Tuesday.

"There are physician practices which have very deep relationships with pharmaceutical representatives, where they are a very integral part of the practice," said Dr. Aaron Kesselheim, an associate professor of medicine at Harvard Medical School who has written about industry relationships with doctors. "Every day it's another drug company coming in for a lunch. Sometimes it may be some drug companies are bringing breakfast and some are bringing lunch and it's just part of the culture of the practice."

Sometimes there may be more at work than that.

The doctor with the second-highest number of interactions with drug and device reps, John Fritz, of Jersey City, N.J., logged payments on 256 days last year. His payments totaled $232,003. Fritz was indicted in June for referring patients to a medical imaging company from 2006 to 2013 in exchange for about $500,000 in kickbacks.

The drugs for which Stankovic received the most money to promote are costly. One, H.P. Acthar Gel, cost an average of nearly $39,000 a prescription, Medicare data from 2013 shows, and experts say there's little evidence it works better than less expensive drugs. Another drug, Soliris, for which Stankovic received promotional payments is among the most expensive drugs in the world but is considered highly effective in treating serious kidney disease.

ProPublica's analysis turned up big differences in the number of industry interactions among physicians in different specialties. On average, doctors who received payments interacted with drug and device companies on 14 days last year, receiving an average of $3,325 in total.

The nation's 3,900 rheumatologists in the data averaged 40 days of interactions with drug and device companies, more than doctors in any other large specialty. They were followed closely by endocrinologists, electrophysiologists and interventional cardiologists. On the other end of the spectrum, dentists, chiropractors, neonatologists and pathologists had among the fewest interactions with drug and device makers.

A spokeswoman for the pharmaceutical industry said in a statement that company interactions with doctors are important. "Collaboration between physicians and biopharmaceutical professionals is critical to improving the health and quality of life of patients," the statement from the Pharmaceutical Research and Manufacturers of America said.

ProPublica has been tracking industry payments to doctors since 2010. Our Dollars for Docs interactive database allowed people to search payments made by 17 companies between 2009 and 2013. Most of those companies were required to report their payments as a condition of legal settlements with the federal government.

The data released Tuesday radically expands the amount of data available to patients. ProPublica has overhauled Dollars for Docs to include these payments. The Physician Payment Sunshine Act, a part of the 2010 Affordable Care Act, mandated that all drug and device companies publicly report payments to doctors. The transparency effort is called Open Payments.

The government initially released some data last fall, covering the period of August to December 2013, but it was significantly redacted because of data inconsistencies. The data released Tuesday covers the period of August 2013 to December 2014. The data inconsistencies have been resolved.

All told, 1,617 companies reported 15.7 million payments valued at $9.9 billion. Nearly all of those payments — 14.9 million — were classified as "general payments," covering promotional speaking, consulting, meals, travel and royalties. They totaled $3.5 billion over the 17-month period.

There were far fewer research payments, 826,000, but they were valued at $4.8 billion. The remaining payments related to ownership or investment interests that doctors had in companies. Research and ownership payments are currently not shown in Dollars for Docs.

Open Payments does not include money spent on drug samples left at doctors' offices and doesn't include the bulk of the money companies spend on independently administered continuing medical education, which they support with unrestricted grants. The government has tightened the rules for reporting such continuing education in the future.

Update, July 8, 2015: Although Stankovic declined to comment for the initial story, she has now provided the following statement:

"I am very passionate about clinical research and up to date medical information; and truly enjoy educating medical professionals on various complicated disease states. There is so much new information to be learned every day in medicine, but simply there is no enough time during the day, especially if provider has a busy medical practice. Many of the interactions that doctors have with pharmaceutical industry are needed in order to stay current with newer FDA approved therapies that may cure illnesses or slow progression of the complicated diseases. Patients should be able to appreciate those medical professionals who can thoroughly discuss all available treatment options on the market and warn them about possible side effects and contraindications."

ProPublica news application developers Mike Tigas and Lena Groeger and senior reporting fellow Annie Waldman contributed to this report.

Check Dollars for Docs to see whether your doctor has received payments from drug or medical device companies. Email us at drugs@propublica.org and tell us what you find.