The University of Kansas Medical Center is investigating whether hundreds of physicians on its faculty may have violated the medical school’s strict rules about accepting free meals and other gifts from drug companies and manufacturers of medical devices.
The inquiry was prompted by questions The Kansas City Star raised after reviewing a recently released federal database of medical industry payments to physicians and teaching hospitals. The data from the Centers for Medicare and Medicaid Services, or CMS, show that the industry paid slightly more than $116,000 in 2014 for food and beverages for 558 physicians who listed KU Medical Center as their primary business address.
Physicians at the University of Missouri-Kansas City School of Medicine also accepted free food and other industry payments, the Open Payments database showed, but their numbers were dwarfed by those at KU.
In a statement, KU said it “has been reviewing the most recent data published by CMS in June. Where considered appropriate, staff are following up with faculty to clarify payment information. … Any corrective or disciplinary actions taken would be handled in accordance with existing university policies and procedures.”
KU’s policy aimed at curbing conflicts of interest between medical center personnel and industry says personal gifts, including meals and tickets for entertainment events, are prohibited, regardless of their value.
“It is strongly advised that no form of personal gift from a vendor be accepted under any circumstances,” the policy says.
While financial relationships between physicians and drug companies may be beneficial for advancing research and medical education, they also may work to the detriment of patients — for example, influencing doctors to prescribe expensive brand-name drugs when cheaper generic pills would work just as well.
Even small transactions, such as a free lunch or a modest fee for speaking to other physicians over dinner, are considered effective ways to influence doctors’ behavior.
Concerns about the influence the health care industry exerts over doctors led to provisions in the Affordable Care Act requiring manufacturers of drugs, medical supplies and devices such as pacemakers, as well as group purchasing organizations, to report their payments to physicians and teaching hospitals.
In addition to food and gifts, these payments include cash, travel, entertainment, consulting and speaking fees, and stock options. Research grants, assistance with continuing medical education and royalties for medical products that physicians helped develop also must be reported.
CMS takes a neutral stand on the meaning of the data.
“Sharing information about financial relationships alone is not enough to decide whether they’re beneficial or improper,” the agency says on its website. “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.”
CMS released some 2013 financial data last year, but the database was incomplete and plagued by inaccuracies. This summer is the first time comprehensive data for a full year have been available.
The Star’s analysis of the database looked at physicians listing a primary business address at 3901 Rainbow Blvd., the same as KU Medical Center. The Star did not determine whether the physicians were full-time faculty members. The Star also did not look for physicians at other addresses associated with the medical center.
The analysis found 3,192 food and beverage payments to 558 physicians at KU Medical Center’s address during 2014. Most physicians received just one or two free meals, according to the data. But 26 physicians received 25 or more meals. And one physician appears to have dined on the industry’s tab 115 times, averaging a free meal every three days.
The average meal payment to the physicians was about $36, but the amounts varied widely. One physician’s seven food payments totaled $928, an average of $132 per meal. Another physician received one meal or drink that was listed at $6.73.
In some cases, these meal payments may have been permitted under medical center policy, KU said. For example, it’s OK for physicians to accept meals at widely attended events, such as continuing medical education programs. In other cases, the payments may have been made through the University of Kansas Hospital, which has its own policies, or while the physicians were doing work outside the university, such as consulting for a drug company.
“Like other institutions of higher education, the university does not prohibit all such personal arrangements,” KU said.
Some medical center physicians are disputing the accuracy of the data.
When KU enacted its conflict of interest policy in 2008, it was seen as one of the most stringent in force at a medical school. At the time, David Robbins, an endocrinologist at KU who headed its drafting committee, told The Star: “We can’t accept as much as a doughnut. Nothing.”
However, on the federal Open Payments website, Robbins is listed as receiving a total of $118 in food and beverages over seven occasions last year from Astellas Pharma US and E.R. Squibb & Sons.
Robbins said he was shocked his name was on the list.
“I have been absolutely strict about this. I haven’t accepted as much as a sandwich,” he said. He suspected that the free meals actually went to another physician with a similar name.
“To sweepingly say people are violating the rules at KU is incorrect,” Robbins said. “I suspect that the database is not very accurate.”
The validity of the data has been questioned by some medical organizations, such as the American Medical Association, that claim physicians haven’t received adequate opportunity to review the information or to challenge its validity.
“Unfortunately, the vast majority of the data released today has not been independently validated by physicians, which makes it less usable for the patients it’s intended to benefit,” AMA president Steven J. Stack said after the database was put online.
KU said the university provides online training regarding conflict of interest issues and “in-person sessions on related topics are periodically offered.”
Physicians on the KU faculty are required to report outside relationships and payments “that reasonably appear to be related to the individual’s university responsibilities,” the university said. “Disclosures are independently reviewed and, where considered appropriate, conflict of interest management plans are put into place.”
The University of Kansas Hospital, which operates separately from the medical school and the other educational divisions of KU Medical Center, received $83,237 from industry for research and $202,937 in other payments, according to the Open Payments database.
Monica Lubeck, the hospital’s chief compliance officer, said many of the payments were probably related to instructional sessions for hospital staff on how to use new equipment. These generally involve employees other than physicians, such as nurses and radiology techs who have “absolutely no ability to influence hospital purchases of equipment or drugs.”
The hospital’s conflict of interest rules are separate from those of the medical center, Lubeck said.
“We will allow our folks to participate in a meal, but it has to be reasonable,” she said — no more often than every few months and nothing too posh.
Lubeck said the Open Payments database is a good, well-intentioned program but still filled with errors. Before the database was made public, physicians and hospitals had a short period to review and challenge inaccurate data. Lubeck said about $3 million in industry payments were attributed to KU Hospital. She successfully challenged about $2.8 million of that amount, but some payments wrongly listed with the hospital may remain.
“I only had so much time,” she said.
“It’s a huge undertaking for schools that are using the data,” said Susan Chimonas, a research scholar with the Institute on Medicine as a Profession at Columbia University and an expert on physician conflicts of interest. However, the database also is “proving to be a very useful tool to medical schools” that want to make sure their physicians are playing by the rules.
More than 90 percent of medical schools now have conflict of interest policies, but their effectiveness varies greatly, Chimonas said. Some schools with tough codes use whatever data are available to check on faculty compliance.
“Other schools have basically just a paper policy,” she said, and only scrutinize faculty who receive large sums from industry or investigate when journalists raise questions.
“But I don’t know of any medical centers that are ignoring the (Open Payments) data entirely,” Chimonas said. “It’s too risky. It can make the school look bad. It’s a public relations nightmare.”