Kansas City-area hospitals vary greatly when it comes to the percentage of their doctors who accept money from drug and medical device companies.
The hospital with the highest percentage is Providence Medical Center, where nearly 89 percent of its doctors took such payments in 2014, the last year for which data are available. The hospital with the lowest percentage is Truman Medical Center Lakewood, where only 43.8 percent of its physicians took payments from those industries in 2014.
Much of the variation has to do with hospital policies governing such payments and how well they’re enforced. Truman, for example, has a policy that it adopted in 2004 spelling out when it’s appropriate to accept payments and limiting drug and medical device representatives’ interactions with hospital personnel.
“In a general way, we’ve said that people shouldn’t accept even the smallest of gifts unless there’s some legitimate work that one is doing on behalf of that pharmaceutical company,” says Dr. Mark T. Steele, chief medical officer and COO of Truman Medical Centers.
“We needed to make sure,” he says, “that we prevented any real or perceived undue influence by industry representatives.”
Elizabeth Nikels, a spokeswoman for Prime Healthcare, which owns Providence Medical Center, says the company requires its physicians to disclose any conflicts of interest in their initial and re-credentialing applications.”
“This includes disclosures of associations with pharmaceutical or other companies,” Nikels said in an email. “We discourage any relationships that may affect physicians’ ability to provide unbiased patient care while ensuring the highest standards of care at all our hospitals.”
Just because a hospital has a high percentage of doctors accepting payments doesn’t mean it has an in-depth relationship with the industry. In many cases, it may simply mean that more of its doctors accepted meals from companies.
But even relatively small payments, including meals, may influence doctors’ prescribing patterns.
A study published online this month in JAMA Internal Medicine looked at physicians who received meals tied to medications for high cholesterol, heart rhythm disorders, high blood pressure and depression. The study’s somewhat surprising conclusion: Even doctors who received just one meal from a drug company were more likely to prescribe that company’s more expensive brand-name drug than cheaper alternatives that are just as effective.
“Even beyond a meal, things as small as a pen or pad of paper can have some undue influence,” Steele says.
In some cases, hospitals boasting relatively low percentages of doctors who took industry payments also had some of the biggest recipients of industry money.
Only 56 percent of the University of Kansas Hospital’s physicians took industry payments in 2004, for example. But three of its doctors were among the Top 10 recipients in the Kansas City area of industry payments.
All members of KU Hospital’s medical staff must be members of the medical school faculty, which is part of the University of Kansas Medical Center.
Natalie Lutz, a spokeswoman for the medical center, said several policies and statutes cover drug company payments to clinical faculty. The medical center’s conflicts-of-interest policy requires its doctors to report all payments above $5,000, she said in an email. Employees are allowed to serve as consultants to the industry – and accept meals in their role as consultants – as long as they disclose any conflicts of interest.
“In addition,” she said, “meals are allowed if they are provided at events that are widely attended, such as a continuing medical education symposium.”
Steele, of Truman, says that the hospital’s status as an academic medical center – it’s the primary teaching hospital for UMKC Medical School – was a major factor in the enactment of its conflicts-of-interest policy.
More than a dozen years ago, Jerome Kassirer, a former editor of the New England Journal of Medicine and author of a book titled “On the Take: How Medicine’s Complicity with Big Business Can Endanger Your Health,” lectured Truman and UMKC doctors about how interactions with drug companies can influence prescribing patterns.
“He was pretty passionate,” Steele says. “ … And we had discussions at a high level and thought we should enact a pretty strict policy around this and agreed that people shouldn't be taking little trinkets that the pharmaceutical representatives wanted to hand out or be going to dinner and things unless it was appropriate.”
Dan Margolies, editor of the Heartland Health Monitor team, is based at KCUR. You can reach him on Twitter @DanMargolies.