Missouri doctors received nearly $74 million in payments from drug and device makers in 2015 in the form of perks that included food and beverages, travel and speaking engagements. Three even went on expenses-paid trips to Hawaii.
The recently released data are all part of the federal government’s efforts to track the flow of medical industry money to physicians, which some health care advocates say can be problematic because it can influence a doctor’s prescribing and treatment habits.
In 2015, about $2.6 billion in general payments were funneled to doctors and teaching hospitals across the United States, according to data recently released by the Centers for Medicare and Medicaid Services. And that does not include approximately $4.8 billion in payments made for research and ownership or investment interests.
This is the second full year the CMS has released the data, which government officials say facilitates comparisons and helps identify trends.
The Post-Dispatch used the data to compile a Top 20 list of the Missouri doctors who received the most industry money in 2015.
The analysis found that half of the highest-paid physicians were also on last year’s list of highest-paid physicians, and a majority of the top earners, when it comes to collecting industry money, practice in the St. Louis area.
The Top 20 doctors in Missouri received a total of $45.4 million in general payments; $5.6 million of that went to St. Louis area doctors.
The three highest earners in the state received a majority of their payments from royalties or licensing fees for the intellectual property they helped develop that companies now sell. Combined, those three doctors — Dr. Roger P. Jackson, orthopedic surgeon of Kansas City; Dr. Robert L. Barrack, orthopedic surgeon of St. Louis; and Dr. William M. Ricci, orthopedic surgeon of St. Louis — account for more than $40 million of the $45 million of total payments made to the state’s Top 20 earners.
Excluding those doctors who received royalties, the highest earner in the state is Dr. Gregory W. Mattingly, a psychiatrist who practices in St. Charles County at St. Charles Psychiatric Associates. He received a total of $520,055 from pharmaceutical companies in 2015. He was also the highest earner in 2014, excluding royalties.
And a previous ProPublica analysis found that compared to his peers across the country, he tended to prescribe more brand-name drugs to certain patients in 2013.
But context is important, said Kelly Dineen, co-director of St. Louis University’s Bander Center for Medical Business Ethics.
There are certain diseases in which many of the treatments are still only available by brand name. And if a doctor is helping a company develop more therapies, and is paid for doing so, it could exacerbate the appearance of impropriety, she said.
She said doctors who are general practitioners and not specialists should draw more scrutiny.
Mattingly, who did not return repeated calls for comment, also holds the No. 1 spot in the state in a category that includes promotional speaking engagements.
He earned the most ($276,189) for speaking engagements in 2015. Mattingly received the second-highest amount in Missouri in the categories for travel and lodging ($80,815) and food and beverage ($11,308).
Arthur Caplan, head of the Division of Medical Ethics at New York University’s Langone Medical Center, said receiving industry money isn’t “always bad.”
The industry is a major source of funding for studies that lead to new drugs, but institutions need to effectively manage the inherent conflicts of interest, he said.
For example, if a study reveals negative findings, it still needs to be published, Caplan said.
But when it comes to taking money for lunches or other gifts, that should be discouraged, he said. “No one is taking a doctor out to a Cardinals game for pure friendship,” Caplan said.
After Mattingly, the next two highest earners from the St. Louis area practice together as neurologists.
Dr. Barry Singer received about $435,000 in 2015, and his partner Dr. Mark Tullman received about $341,500. Their practice is the MS Center for Innovations in Care and is located on BJC HealthCare’s Missouri Baptist Medical Center campus in Town and Country.
They disclosed their financial relationships with the industry on their practice’s website.
They, too, are near the top of the list for receiving promotional speaking fees and are ranked among the top 10 for travel and lodging. Singer was also among the top 10 in the state for payments made for food and beverage.
In a statement, Singer and Tullman said: “Treating multiple sclerosis has become increasingly complex and we feel it is essential to educate patients and health care providers regarding the appropriate uses, benefits, and risks of the various treatments.”
Both doctors were identified in an earlier analysis by ProPublica as doctors who tend to prescribe more brand-name drugs on average compared to their peers across the country.
However, Caplan said an important caveat to remember is that many physicians are beholden to the formularies, or list of preferred drugs they can prescribe their patients that is either set by the hospital they work for, or the patient’s insurance company.
Still, there were three doctors in the state of Missouri that went on trips to Hawaii thanks in part to industry money. That’s becoming rare, said Dineen and Caplan.
That’s because pharmaceutical companies today face a lot of scrutiny and don’t want to appear as being extravagant.
Dr. Henry Nasrallah, who chairs St. Louis University’s Department of Psychiatry and Behavioral Neuroscience, went to Hawaii in February 2015 thanks to a total of $3,540 from Massachusetts-based drug maker Sunovion in relation to its drug Latuda.
Nasrallah said he went on the trip to educate Hawaiian physicians about the treatment for bipolar depression.
“I feel I am doing a lot of good for the patients in Hawaii or wherever I go to teach the practitioners on how to use the medication appropriately,” he said.
Dr. Roger Huckfeldt of Nixa went in March 2015 thanks to $2,055 from New Jersey-based Ansell Healthcare Products in relation to a respirator and surgical mask.
Dr. Craig Leonardi traveled in late January 2015 with $532 from Illinois-based AbbVie for its drug Humira.
Huckfeldt and Leonardi did not return repeated calls for comment.
Hawaii, Caplan said, “is a lot of money, it’s expensive and people suspect there is more than just papers being presented.”
To review the entire CMS database, go to cms.gov/openpayments.
Walker Moskop of the St. Louis Post-Dispatch contributed to this report.