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CardioBrief: Dollars for Heart Docs

— Analysis of CMS database shows some docs pocketed millions from drug and device makers.

Last Updated August 18, 2015
MedpageToday

$300 million dollars. That's how much industry paid to cardiologists and other related healthcare professionals between August 2013 and December 2014 for consulting, speaking, and other various activities, according to new data published by CMS in the Open Payments database. The $300 million figure does not include even larger sums in the database paid by industry to support research or for ownership or investment interest, and there are other gaps as well.

By way of background, as required by the Sunshine Act, to include industry payments to physicians for the year 2014, the first full year of reporting (which began in August 2013). The database now covers nearly $10 billion dollars of payments, including $3.53 billion in general payments, $4.78 billion in payments for research, and $1.61 billion for ownership or investment interest.

Digging Into the Data

Like many of my readers, I'm pretty sure, I've wondered how cardiologists fit into this story. Unfortunately, although the and the make it easy to look up the payment history for individual physicians or companies, trying to do more with the enormous and complex databases published by CMS is a forbidding and difficult task. I started out trying to isolate the data from cardiologists (and other related health care professionals and specialties) and almost immediately ran into a host of obstacles.

One immediate and counterintuitive problem is that it's really difficult to generate a simple list of cardiologists and other cardiovascular healthcare professionals included in the CMS data. The problem is that, in the main payment database, physician specialties are listed by individual companies in completely different and inconsistent ways. To get around this problem I asked a knowledgeable expert for help. The result is a spreadsheet that lists the total amount of payments to any healthcare provider in a cardiovascular specialty. (For more on this see the note at the bottom of the story.) For much more on the difficulties of trying to work with the CMS data see .)

At the bottom of this story I've provided links to spreadsheets containing the raw and filtered data, as well as a list of docs who received more than $1 million from August 2013 until the end of 2014.

An important limitation to the Open Payments database is that it does not include all payments to physicians or other medical organizations. An especially enormous hole is that it does not currently include payments for the commercial support by industry to continuing medical education (CME). The ACCME recently reported that, in 2014, industry spent $675 million on CME. Undoubtedly a good chunk of this money has gone to cardiovascular KOLs, as any attendee of a major cardiology meeting or viewer of online medical content is likely aware, given the dizzying number of commercially supported CME programs for new cardiovascular drugs and devices. In addition, the database does not include payments to medical organizations and societies, like the American Heart Association or the American College of Cardiology.

A Few Observations about a Lot of Money

It's difficult to understand or put in perspective the raw data, especially since we have so little detailed knowledge of what exactly most of these payments are for. Of course we already knew that cardiovascular drugs and devices were a very big business. When the 2014 data were released, showing that three cardiovascular drugs -- Xarelto, Eliquis, and Brilinta -- were in the top 10 drugs promoted by industry. Three other drugs in the top 10 -- the diabetes drugs Bydureon, Invokana, and Victoza -- were also in the top 10, and these also undoubtedly were responsible for significant industry payments to cardiologists.

Here are some of the highlights of the list, which covers the period from August 2013 through December 2014 (large numbers have been rounded).

31,379 doctors received a total of $299,050,686.84:

  • 26,000 received more than $100
  • 15,000 received more than $1,000
  • 5,700 received more than $5,000
  • 3,700 received more than $10,000
  • 2,000 received more than $25,000
  • 1,000 received $50,000
  • 460 received over $100,000
  • 122 received more than a quarter million dollars
  • 40 received over half a million dollars
  • 17 received over a million dollars.

There were 1.4 million individual payments to doctors on the list:

  • 48,000 payments for different forms of speaking, for a total of more than $150 million.
  • 17,000 for consulting, for a total of more than $45 million.
  • 1.2 million for food and beverage, for a total of $36 million.
  • 97,000 for travel and lodging, for a total of $35 million.

Number of payments linked to individual drugs (some payments were linked to multiple drugs):

  • Eliquis: more than 145,000 payments
  • Xarelto: more than 124,000 payments
  • Brilinta: more than 116,000 payments
  • Pradaxa: more than 74,000 payments
  • Efient: more than 67,000 payments

Cardiovascular Devices Are King

One great way to get a lot of money from industry is to develop a new interventional cardiology device and sell it to a big device company. This is how nearly all the big million dollar recipients of industry funds earned their place on the list.

The top recipient, Sanjay (Jay) Yadav, received $23 million in conjunction with the FDA approval of his CardioMems Heart Failure system and its sale to St. Jude Medical.

Number two on the list is Sanjiv Narayan, a founder of Topera, a manufacturer of AF ablation systems, which was sold last year to Abbott for an initial price of $250 million. He received $11 million. Eric Prystowsky, number 5 on the overall list, also received more than $2 million from the Topera sale. Benzy Padanilam received just over $1 million.

The interventional device company Penumbra accounts for Harry Kopelman's $3.5 million and Nicholas Lembo's $2.7 million.

TV's famous Mehmet Oz received $1.17 million from Covidien/Medtronic for his ownership stake in HET Systems, a company which sells a hemorrhoid energy therapy system. No comment.

Other million dollar payments went to Frederick St. Goar, a founder of Evalve, which was bought by Abbott; Craig Walker, a founder of Idev Technologies, which was bought by Abbott Vascular; and Klaus (Peter) Rentrop, who sold a laser atherectomy catheter to Spectranectics.

Cardio's Million Dollar Club

Routine Payments For Speaking And Consulting

But many thousands of other cardiovascular healthcare professionals who didn't invent a device or start a company also received a lot of money from industry. By far the most common payments in the database were for more routine activities like consulting and speaking, along with the inevitable associated travel and entertainment expenses.

Matthew Budoff appears to be the most highly compensated doctor on the list who did not sell a company or a device. He received more than $950,000 from industry from August 2013 through 2014. Nearly half, $450,000, came from Pfizer for consulting and speaking on behalf of Eliquis. He also received large sums from Fukuda Denshi ($147k) and from the makers of Brilinta ($131k). Smaller but still considerable payments were received in relation to Crestor ($54k), Invokana ($47k), Computed Tomography ($40k), Xarelto ($36k), and Vascepa ($35k).

Peter Zimetbaum received $657,000, almost all of it from Forest Laboratories, where he serves on the board of directors. In addition to compensation for his board duties, it appears that he also receives significant sums from the company for promotional talks and consulting.

Peter Kowey received $540,000. $157k was for consulting concerning a cardiac monitoring suite manufactured by Braemar Manufacturing. He also received $57k related to Eliquis, $27k related to Xarelto, and $17k for consulting for Salix Pharmaceuticals in relation to Relistor.

Number 66 on the list is Philip Sager, who received $354,000 from industry. Most of this went to his consulting company, Sager Consulting Experts, and came from Theravance Biopharma. It is worth pointing out that Sager has served several times as a member and the chair of the FDA's Cardiovascular and Renal Advisory Committee. (The FDA, of course, has rules regarding conflict of interest for its advisers.) Another frequent FDA panel member, Sanjay Kaul, earned $265k during the same period.

listing the total payments to more than 31,000 cardiology healthcare professionals. (Please note that this spreadsheet contains raw data from CMS and is quite unwieldy.)

listing the total payments to the 2,000 cardiology healthcare professionals who received more than $25,000.

Use the and the to look up the payment history for individual physicians in these two spreadsheets.

Note: As mentioned above, in the main Open Payments database, physician specialties are listed by individual companies in completely different and inconsistent ways. My helpful expert was able to search the general payments database for any specialty containing the string "cardi" and then compile all the available data for the individual physicians. This list was then cross-referenced against the government-managed National Provider Identifier system to generate a more comprehensive list.