Physicians associated with Kansas and Missouri hospitals received about $46 million in payments from drug and medical device companies in 2014, with about 9 percent going to providers in the Kansas City area.
A database compiled by ProPublica shows the companies paid about $4.1 million -- excluding an outlying $9 million payment to one physician for royalties -- to physicians associated with hospitals in greater Kansas City, and $1.7 million to those working with hospitals in the greater Wichita area.
It isn’t illegal for doctors to accept meals, speaking fees and other forms of compensation from drug and medical device companies, as long as they don’t receive kickbacks for prescribing certain medications or devices. Some studies have found, however, that doctors who accept payments tend to prescribe more expensive drugs more frequently than generics, at least in certain cases.
Doctors who received more payments were more likely to prescribe the expensive drugs than those who received smaller amounts, though that doesn’t prove the payments caused the prescribing, or that doctors who received payments intentionally did anything differently.
In addition to being geographically concentrated, most of the money went to relatively few physicians. About $2.7 million, or more than a third of the money the industry spent on doctors in Kansas, went to the top 15 recipients – or 0.5 percent of the roughly 2,800 doctors who received some form of payment. Similarly, nearly $20 million, or about half the money the industry spent on doctors in Missouri, went to the top 15 Missouri recipients -- out of a total of more than 7,000 who accepted payments.
The Missouri numbers, to be sure, were skewed by one huge outlier – $9million to Roger Jackson, who specializes in orthopedic surgery and invented a surgical table for which he receives royalties. Jackson was far and away the top recipient of industry money in either Kansas or Missouri.
While sorting doctors by the hospital where they work can be instructive, the hospital may not be directly affected by what doctors choose to accept. For example, Steven M. Simon, a physical medicine and rehabilitation specialist, received nearly $542,000 in industry payments – making him one of top recipients of industry money in the Kansas City area. But most of the money was related to his private practice, Mid-America Physiatrists in Overland Park, and not to his affiliation with Shawnee Mission Medical Center.
In a telephone interview, Simon said half or more of the money he received was reimbursement for expenses like air fare and hotels. He said he frequently lectures on medications to other providers, necessitating frequent travel.
“These are FDA-approved programs sponsored by the pharmaceutical company to familiarize physicians with product,” he said.
Similarly, David Michael Wichman, a Wamego, Kansas, psychiatrist who accepted $137,239 in payments, mostly for speaking, said he speaks at continuing education events on his own time and doesn’t consider it related to his affiliation with Wamego Health Center.
Wichman said most of his presentations are to physicians working in rural areas of Kansas and Nebraska. The presentations cover newer psychiatric medications, including antipsychotics and antidepressants, he said.
“A lot of it is going out and talking to family physicians that are struggling to treat psychiatric patients,” he said.
The Food and Drug Administration regulates what information can be included in presentations and requires the speaker to cover how the medication works, side effects and studies the FDA used when deciding whether to approve the drug, Wichman said. Half of the presentation can’t be about a specific drug, but must include general information like how to manage bipolar disorder, for example, he said.
“You can only give that unbiased, this is what the drug is, this is what it does” information, he said.
Wichman said he had done some teaching since he was chief resident at University of Kansas Medical Center in 2008, and gradually been speaking at continuing education events and events discussing pharmaceuticals. He said he supports publishing information about physicians’ finances and prescribing patterns, but thinks concerns about pharmaceutical payments influencing physician behavior may be overblown.
Doctors who attend a presentation about a new drug typically are interested in what it could do for their patients, Wichman said. If that drug offers an advantage, such as reduced metabolic side effects from new antipsychotic drugs, patients benefit, he said.
Doctors “didn’t go to that many years of schooling to be ‘bought’ for a $20 meal,” he said.
The insurance system also limits doctors’ ability to get too eager about a new drug, Wichman said. Most insurers use a form of step therapy, so doctors have to show that their patients aren’t doing well on a cheaper generic before trying a more expensive brand-name drug, he said.
“A lot of these patients that are on the brand-name medications are patients that have failed on two or three non-branded generic medications,” he said.
Megan Hart is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team. You can reach her on Twitter @meganhartMC
Dan Margolies, editor of the Heartland Health Monitor team, is based at KCUR. You can reach him on Twitter @DanMargolies.