Think Again: Payments to doctors By Eric Novack

I am frankly a bit surprised at the lack of comment at THCB on the recent orthopedic device manufacturers’ settlement with the government for concerns about illegal payments to physicians.  I would have expected Matthew or Maggie, at least, to be sounding the alarm over the dangers of the private sector in healthcare. The most interesting byproduct of the settlement is the development of a public database where you can search by company to see who is getting the ‘big bucks’.

But like many simple statistics, the data can be misleading.

Let me be clear—paying a surgeon for ‘work’ with the real expectation that he or she will use a specific product is unethical, not to mention illegal (but a problem inherent in our 3rd party payment
system in medicine, but that is another issue entirely…).

One Phoenix area surgeon has been paid $3 million this year by Stryker.

‘Outrageous’, you say. “Ah- ha—see, all doctors are corrupt and need to be controlled”, others exclaim.  But what are the facts?  In this case, the surgeon helped develop some of the early hip and knee replacement designs… These designs have served as the basis for literally millions of replaced joints over the last 20 years.  He owns a piece of the patent.Is it immoral to get paid for people using a product you work hard to develop?  Should Google’s founders still benefit?  How about those who own patents on everything vacuum cleaners to hair care products?

Of course they should-- because our society encourages innovation by protecting the value of innovation.

Other names in the database are, and should be, areas for concern. While I do not want 3rd parties to define what my ‘value’ is for services I provide, clearly some of the amounts appear to be so far outside the ‘norm’ as to necessitate questions. If surgeons or organizations are effectively getting ‘kickbacks’ for nearly exclusively utilizing products in high volume—and threatening, in any way, to cease using the implants unless payment is forthcoming—they should be identified and their actions be made very public.

Patients ought to be able to know and understand the nature of those relationships and decide whether or not they want to seek care, or opinions, from as many other surgeons as they wish.

Regulators ought to understand that their goal ought to be fraud protection and prevention—not with the aim of punishment of providers (though, understandably this is at times necessary)—but rather with
the aim to PROTECT THE RIGHTS OF INDIVIDUALS.

EDITOR'S NOTE: For more on the issues involving questionable payments to physicians by device manufacturers, see this very detailed post by Roy Poses at Brown.