Medicaid programs slow to act against system exploiters
Filed under: Conflicts of interest, Health data, Hot Health Headline, Public records
At ProPublica, senior reporters Charles Ornstein and Tracy Weber have published the latest turn in their ongoing analysis of conflicts of interest, problem physicians and the disciplinary systems meant to reign them in. This time, they look at Medicaid in Florida and find at least three instances when the state “allowed physicians to keep treating and prescribing drugs to the poor amid clear signs of possible misconduct.”
Their piece revolves around those key examples – two of which were, in all seriousness, brought to their attention by a Scientologist-run watchdog website – and I strongly recommend you read the whole thing for the details. Below, I’ve just highlighted the bigger picture.
In general, Ornstein and Weber found, state Medicaid programs, as well as the federal Centers for Medicare and Medicaid Services, which doesn’t track relevant state data, have failed to act on information which seems to strongly indicate that certain physicians are abusing or exploiting state programs.
Medicaid programs across the country have long had evidence that physicians have been prescribing risky drugs in excess and perhaps to the wrong patients. These prescriptions also racked up huge bills for the programs.
But like Florida, many states did not act on that evidence. Last year, (Sen. Charles) Grassley demanded data from each state about its highest prescribers of pain pills and antipsychotics, and he asked state and federal officials to determine whether the prescriptions written by these doctors were legitimate.
Pharma discloses free meals, ProPublica expands database
Filed under: Conflicts of interest, Government, Health care reform, Health data, Health journalism, Hot Health Headline, Member news, Pharmaceuticals, Public records, Tools
In his latest report, ProPublica senior reporter and AHCJ board president Charles Ornstein explains exactly how, since its founding last October, ProPublica’s Dollars for Docs database of pharma payments to physicians has mushroomed from 30,000 entries to more than half a million. They answer, he writes, has a lot to do with free meals and other perks that pharmaceutical companies are starting to publish ahead of strict federal disclosure regulations which will go into effect in 2013.
Pharmaceutical company representatives say the meals serve an important educational purpose, and they have adopted their own set of rules for such interactions.
A voluntary code of conduct adopted by the Pharmaceutical Researchers and Manufacturers of America says that “it is appropriate for occasional meals to be offered as a business courtesy” to doctors and members of their staffs attending information presentations by sales reps.
In such cases, the guidelines say, the presentations have to “provide scientific or educational value,” and the meals should be “modest” by local standards and not part of an entertainment or recreational event. Meals for spouses and take-out meals are not appropriate, the guide says.
To put it all into perspective, Ornstein demonstrates with numbers from Pfizer that, while the meal numbers have certainly increased the number of entries in their database, they haven’t had as significant an impact upon the overall dollar amounts in question.
Relatively, the meals didn’t add up to much money. Pfizer’s meals amounted to only $18 million last year, compared to $34 million for promotional speakers and $108 million for research.
As with previous installments, Ornstein, Tracy Weber and Dan Nguyen’s database work has spawned follow-up reports around the country. In fact, the response was such that Ornstein and Weber even took the step of re-nationalizing the localizations of their story, with the follow-up “News Reports Cite Drop in Physician Speaking Fees.” Below, I’ve linked to a few notable localizations and follow-up stories. If you’ve got another one to point out, add it in the comments.
- A Dozen Pharmas Make Payments to Physicians Public, Kathlyn Stone, About.com
- Drug firms disclose spending on meals, Liz Kowalcyzk, Boston Globe
- How To Find Out If Your Doctor And Drugmakers Are In A Relationship, Scott Hensley, NPR
ProPublica investigates ties between doc groups, industry
Filed under: Conflicts of interest, Health data, Hot Health Headline, Pharmaceuticals
With an assist from Sen. Chuck Grassley, ProPublica senior reporters Tracy Weber and Charles Ornstein, AHCJ’s board president, have published their latest data-heavy investigation (USA Today version). This time, their journey into the myriad avenues pharmaceutical companies pursue to influence physicians has taken them into the world of professional societies and annual conferences. The duo writes that despite the power of these groups, their dependence upon millions and millions of dollars in industry funding has often slipped under the radar.
Professional groups … are a logical target for the makers of drugs and medical devices. They set national guidelines for patient treatments, lobby Congress about Medicare reimbursement issues, research funding and disease awareness, and are important sources of treatment information for the public.
Their strongest anecdote comes from the Heart Rhythm Society, a group which, in 2010, pulled in about $8 million – half their total income – directly from manufacturers of the drugs and devices their members specialize in prescribing for, or implanting in, patients. The society has started to disclose these relationships, but perhaps not to limit them, the reporters write. “’This is our business,’ said Dr. Bruce Wilkoff, the incoming society president. ‘We either get out of the business or we manage these relationships. That’s what we’ve chosen to do.’”
The companies also pay two-thirds of the society’s board members speaking or consulting fees, a situation Weber and Ornstein found is far from unusual. In addition to these financial conflicts, the reporters gathered some fascinating examples of just how deep industry influence can run. My personal favorite comes from the conference of a well-known collection of cardiologists.
Last month, the American College of Cardiology attached tracking devices to doctors’ conference ID badges. Many physicians were unaware that exhibitors had paid to receive real-time data about who visited their booths, including names, job titles and how much time they spent.
For more examples, I recommend Robert Durrell’s photographs from the 2011 Heart Rhythm Society annual conference, which show dozens of industry-sponsored objects alongside the amount of money each company paid for that particular privilege. Dan Nguyen and Nicolas Rapp put together an infographic that expands upon a similar theme.
Much of the disclosure data the ProPublica team depended on for their reports was released in response to a request for informationGrassley sent out in late 2009. His investigation has started to yield some preliminary results.
There are fledgling efforts to push medical societies toward stricter limits on industry funding: 34 groups have signed a voluntary code of conduct calling for public disclosure of funding and limits on how many people on guideline-writing panels have industry ties.
“The general feeling is that the societies need to be independent of the influence of companies,” said Dr. Norman B. Kahn Jr., chief executive of the Council of Medical Specialty Societies, which helped draft the code.
Carlat reviews Dollars for Docs, and the bleak picture it paints
Filed under: Conflicts of interest, Health data, Health journalism, Public records, Tools
Writing on KevinMD.com, psychiatrist and blogger Daniel Carlat reviews ProPublica’s Dollars for Docs database from the perspective of a medical professional, one who has taken a firm stand against drug company money and the conflicts of interest it brings. Carlat’s real focus is not the Dollars for Docs project, but rather the data available from drug companies. He does point out some limitations inherent in the data ProPublica is working with. And he writes about a slightly inverted use of the data, one which caused him to ask “How have we allowed this to happen to our once proud profession?”
There’s another way to use the Dollars for Docs database, although this is not spelled out on the website. If you want to browse for all the doctors in your city or state who are “on the take,” simply leave the “name” field blank, choose a state from the drop down menu, and click search. You’ll get a huge spreadsheet which is arranged alphabetically by last names of the doctors. By clicking on the various columns, you can sort the data by city, drug company, amount of money, or time period of the payments. This is a nice feature that is absent from most of the drug company databases.
Carlat’s data trick is a simple one, and one which local reporters should take a minute to replicate if they haven’t already. After reviewing the mountain of local data revealed by his sorting and the vast armies of conflicted doctors it implies, Carlat reminds us of the power of pharma money then drives home the sheer magnitude of the issue.
The true malfeasance here is in the aggregated effect. The companies are using these legions of doctors to artificially manipulate medical discourse. Any doctor who participates in the enterprise knows exactly how they are being used. You decide whether this is “immoral” or not.
ProPublica finds academic physicians violating schools’ conflict rules
Filed under: Health data, Health journalism, Hospitals, Hot Health Headline, Pharmaceuticals, Public records, Tools
While journalists have been finding innovative ways to use ProPublica’s Dollars for Docs database, the database’s founders, Tracy Weber and AHCJ President Charles Ornstein remain ahead of the curve when it comes to using the freely available data for fresh stories.
This time around, the duo looked for medical schools with strict conflict-of-interest policies and ran their faculty lists through the database. They found dozens of matches, even at elite research institutions. It’s an idea so effective that it’s a wonder nobody thought of it sooner – and apparently the institutions involved feel the same way.
“For God’s sake, if the media can look at these websites, why can’t we?” said David Rothman, president of the Institute on Medicine as a Profession at Columbia University. “Why trust if you can verify?”
Stanford, the University of Pennsylvania, the University of Colorado Denver and the University of Pittsburgh drew particularly heavy attention. (On the other side of the coin, UMass Memorial Health Care was singled out as an example of a robust conflict policy.)
Pizzo, Stanford’s dean, said physicians who appear to have violated the policy will be investigated and referred for discipline if necessary. He compared some of their explanations to what a cop might hear after catching a motorist running a late-night stop sign.
“You can give 1,000 reasons: There was nobody around. It’s safe. I looked and didn’t harm anyone,” he said. “The reality is, it’s still a stop sign.”
Watch the full episode. See more Nightly Business Report.
And this isn’t just a database story. Weber and Ornstein also found time for a review of various academic conflict of interest policies and point out how policies are weakened through inaction, loopholes and a reliance on self-policing.
ProPublica investigates pharma payments to doctors
Filed under: Conflicts of interest, Health care reform, Health data, Health journalism, Hot Health Headline, Pharmaceuticals, Public records, Tools
ProPublica’s massive investigation into the hefty fees pharmaceutical companies have paid doctors with dubious track records stamps an exclamation point on what has been a banner year for high-profile assaults on pharma-paid physician/marketers.
Books like Daniel Carlat’s Unhinged and Carl Elliot’s White Coat, Black Hat, and the promotional tours that came with them, led the charge and raised awareness of an issue that reporters Charles Ornstein (you may know him as AHCJ’s president), Tracy Weber and Dan Nguyen have driven home with tens of thousands of carefully researched data points and one flagship story.
The ProPublica database is built upon the voluntary disclosures of seven drug manufacturers (Eli Lilly, Cephalon, AstraZeneca, GlaxoSmithKline, Johnson & Johnson, Merck & Co. and Pfizer) which represent about 36 percent of the market. Reform law requires the other manufacturers to make similar disclosures by 2013. The package uncovered a bucket of horror stories — that mug shot of high-earner Dr. Donald Ray Taylor next to the paragraph describing why he was disciplined is the very definition of “disturbing” — yet also distinguished itself by giving doctors who rep pharma the opportunity to explain both their work and their motivation.
In its examination of pharma payments, the investigation goes beyond a simple database match with disciplinary records. Some physician/marketers had clearly earned their stripes and displayed impressive resumes and relevant research records, the reporters found, but others had disciplinary records, lacked any board certification or publications or appeared to have been manufactured by the drug-makers themselves.
“It’s sort of like American Idol,” said sociologist Susan Chimonas, who studies doctor-pharma relationships at the Institute on Medicine as a Profession in New York City.
“Nobody will have necessarily heard of you before — but after you’ve been around the country speaking 100 times a year, people will begin to know your name and think, ‘This guy is important.’ It creates an opinion leader who wasn’t necessarily an expert before.”
If you can’t get enough of the investigation, see the work by ProPublica’s partners at The Boston Globe, Consumer Reports, the Chicago Tribune, Nightly Business Report and NPR.
Finally, don’t miss the comments on the article, headlined by a lengthy response from the leading pharmaceutical industry group.
Agreement lets disciplined nurses work in 24 states
Filed under: Health data, Health journalism, Nursing, Public records
ProPublica’s Tracy Weber and Charles Ornstein are back on the disciplined caregivers beat, this time cooperating with USA Today to expose a licensing gap that makes it easier for disciplined nurses to find work in other states. The licensing agreement in question was signed a decade ago as 24 states agreed to recognize each other’s licenses in an attempt to alleviate care shortages by allowing nurses to work where they are needed most.
In some cases, nurses have retained clean multistate licenses after at least one compact state had banned them. They have ignored their patients’ needs, stolen their pain medication, forgotten crucial tests or missed changes in their condition, records show.
Critics say the compact may actually multiply the risk to patients. There is no central licensing for the compact, so policing nurses is left to the vigilance of member states.
Outside the compact, each state licenses and disciplines its own nurses. But within it, states effectively agree to allow in nurses they have never reviewed.
Ornstein and Weber found numerous instances in which a caregiver disciplined in one state was able to work for an extended period in another without being red-flagged, and are helping spark a debate over the costs, benefits and implementations of such agreements.
New federal caregiver database full of holes
Filed under: Hot Health Headline, Public records, Tools
Tracy Weber and Charles Ornstein are still working with databases of disciplined caregivers, this time exposing gaping holes in the federal database released to hospitals on March 1 (LA Times version | ProPublica version). Weber and Ornstein trace the holes to a lack of reporting by state agencies, and mention California, South Dakota, New Hampshire, Alabama, Delaware, Ohio, Tennessee, Indiana as states whose database entries were demonstrably incomplete. Some states don’t even have a single disciplined caregiver showing up in the federal database even though scores of offenders are listed on those states’ own sites.
The omissions took federal health officials by surprise. Only last month, a spokesman for the agency that oversees the database told reporters that “no data is missing.” Another official said the agency had been “constantly” checking its data against state licensing board websites.
But Friday, the head of the Health Resources and Services Administration (HRSA) acknowledged that records were missing. She said her agency had launched a “full and complete” review to determine what is wrong and how to fix it.
The Department of Health and Human Services has reacted swiftly, Ornstein and Weber report. HHS boss Kathleen Sebelius sent U.S. governors a letter requesting that they identify and correct any holes in the federal database by June 1, at which point any states whose entries were not updated will be named and shamed in an HSS report. HHS will train state staff in compliance and audit the database to make sure everybody’s following the rules. States have, as of yet, not faced any penalties for failing to update the list over the preceding two decades.
LA reporting team moves to New York
Charles Ornstein and Tracy Weber have taken their award-winning partnership to ProPublica as senior reporters. The duo helped deliver a Pulitzer Prize in public service journalism to the Los Angeles Times in 2005 for coverage of poor management and dangerous care at King/Drew hospital.
Ornstein
Now, they’ve written about gaps in the oversight of nurses with criminal records in California—a collaboration between ProPublica and the LA Times. Says Ornstein about moving into the nonprofit journalism world: “It’s not as different as you may think. I’m working with extremely talented colleagues, and everyone here is committed to accountability journalism. Hopefully this is a way forward for our industry.”
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