–Cardiologists received more than $200 million from industry in 2015.
In 2015 cardiologists and other cardiovascular specialists received more than $200 million dollars from industry, according to new data released by Medicare.
More than 30,000 physicians in cardiovascular medicine received industry payments in 2015, though many of these payments were relatively small amounts. But more than 12,000 doctors received more than $1,000, more than 4,500 received more than $5,000, and more than 1,600 received more than $25,000. 846 doctors received more than $50,000, 336 received more than $100,000, and 100 received more than $200,000. Finally, up in the stratosphere, 17 received more than $500,00 and 10 received more than $1 million.
It should be noted that the $200 million overall figure does not include payment for research, which is listed separately by Medicare. The figure also excludes payments to doctors for teaching CME (continuing medical education), an important exception since for many top academic physicians this has become their major source of industry-derived income.
The best way to make a whole lot of money from industry was to sell a device or a device-related company to one of the big device companies. That’s how nearly all the doctors who received more than $500,000 in 2015 earned their pay. (See “The Million Dollar Club” below.) At the other end of the list many thousands of doctors r eceived small sums from industry; more than 5,000 received less than $100 in 2015, generally in the form of food and beverage. (Baback Adibi of North Bergen, NJ gets the award for the smallest amount, $1.16, for “food and beverage” from Zoll, though I suspect, given the payment size, in this case it was for food or beverage.)
They Work Hard For The Money
Near the top of the list are hundreds of doctors who make large sums of money speaking for and consulting with pharmaceutical and device companies.
For the second year in a row Matthew Budoff (Harbor-UCLA Medical Center) appears to be the most highly compensated doctor on the list who did not sell a company or a device. In the 17 months prior to 2015 he received more than $950,000 from industry. In 2015 he received $444,000 in payments for consulting and speaking, including $109,000 from AstraZeneca, $79,000 from Pfizer, $76,000 from Squibb, $69,000 from Janssen, $37,000 from Amgen, $36,000 from Amarin, and smaller amounts from 12 additional companies. (For serving as a principal investigator in clinical trials Budoff also received $254,000 from ER Squibb, $203,000 from Pfizer, $123,000 from Amgen, and $102,000 from Astellas.)
Over the course of a week in January Budoff received multiple payments from Pfizer and Squibb, apparently for speaking about Eliquis (apixaban). (Remember that Budoff was also paid to perform research on the same drug.) In addition to the payments listed below, which include multiple payments on the same day, he was also reimbursed for travel and food expenses. During the same week he also received $6,500 in consulting fees from Amarin. Here are his main payments (travel and food expenses excluded) for the week:
- January 22: $2,500 from Pfizer
- January 23: $2,500 from Pfizer
- January 23: $2,500 from Pfizer
- January 26: $1,500 from Amarin
- January 28: $3,500 from Amarin
- January 28: $3,200 from Squibb
- January 28: $3,500 from Squibb
- January 29: $1,500 from Amarin
- January 29: $1,920 from Squibb
- January 28: $3,200 from Squibb
- January 28: $2,400 from Squibb
Here are some other well known names among the top earners:
- Gary Martin Ansel (University of Toledo Medical Center) received over $700,000 from industry, most of which came from Cook Medical, for whom he has been a frequent consultant and investigator.
- Puneet Khanna (Rancho Mirage, CA) received more than $510,000 from Medtronic and $75,000 from Ablative Solutions.
- Eric Prystowsky (St. Vincent Hospital) received $514,000 from industry, including $240,000 from Medtronic, $130,000 from Braemar Manufacturing, $78,000 from Stereotaxis, and $51,000 from Abbott.
- Robert Hauser (Minneapolis Heart Institute) received $448,000 for an investment or ownership in Boston Scientific and $33,000 from St. Jude for a return on investment
- Chris Cannon (Brigham & Women’s Hospital) received over $400,000 from industry, more than $300,000 of which came in the form of consulting fees from Boehringer Ingelheim.
- Eric Topol (Scripps) received $388,000 from industry, most of which came in the form of stock options from Dexcom, Inc, which makes a portable continuous glucose monitor.
- Eric Rose (Mt. Sinai) received $319,000 consulting for Abiomed.
- Matthew Price (Scripps) received $196,000 as the principal investigator for studies sponsored by Medtronic ($136,000), St. Jude ($33,000), and Abbott ($22,000). He also received $295,000 in consulting, speaking, and honorarium fees from 22 companies, including $80,000 from AstraZeneca, $76,000 from St. Jude, $40,000 from Boston Scientific, $29,000 from Medtronic, $22,000 from the Medicines Company, $15,000 from Terumo, and $11,000 from Spectranetics.
- Peter Kowey (Lankenau Institute) received $271,000 in consulting and speaking fees from 27 companies, including $66,000 from Braemar Manufacturing, $32,000 from Sanofi-Aventis, $32,000 from GlaxoSmithKline, $19,000 from Medtronic, $19,000 from Novo Nordisk, $15,000 from AstraZeneca, and $12,000 from ER Squibb.
- Jeffrey Borer (Downstate Medical Center), who has been a member and chairperson of both the FDA’s Cardiovascular and Renal Drugs Advisory Committee and the Circulatory Systems Device Panel, received $245,000 in consulting fees from 11 companies, including $163,000 from Amgen, $30,000 from Pfizer, and $20,000 from Takeda.
- Kenneth Mahaffey (Stanford) received $175,000 from Janssen as the principal investigator of a rivaroxaban (Xarelto) study. He also received $231,000 in consulting fees from 7 companies, including $151,000 from Janssen and $32,000 from the Medicines Company.
Board of Trustees
- R Sanders Williams, president of the Gladstone Institute, received more than $800,000 for serving on the board of trustees of Bristol-Myers Squibb and Amgen.
- W. Gerald Austen (Harvard Medical School and Massachusetts General Hospital) received $587,000 from Abiomed for serving on the board of directors.
- Elizabeth Nabel, who is the president of Brigham & Women’s Hospital as well as the Chief Health and Medical Adviser to the National Football League, also received $371,000 for her role on the board of trustees of Medtronic.
The Million Dollar Club
The 10 doctors who received more than $1 million from industry did so for selling a device or a device-based company to industry.
- The top spot in 2015 went to Gust Bardy , a founder of Cameron Health, which developed the subcutaneous ICD which was purchased by Boston Scientific. He received $4.395 million for his stake.
- The second spot went to Stanford cardiothoracic surgeon James Fann, for his ownership stake in a transcatheter mitral valve replacement company, Twelve, Inc, which was bought by Medtronic. He received $4.272 million. Gasevoort Dunningtion (Clearlake, CA) received $573,000 from industry, $350,000 which came from Medtronic for his stake in Twelve, Inc. Dunningtion also received $219,000 from AtriCure, most of which appears to be for consulting for the company, but $25,000 is listed simply as a gift.
- Brian Keith Whisenant (Intermountain Health Care) received $2.876 million in 2015, most of which came from Biosense Webster, which purchased a company he founded, Coherex Medical, which is developing a PFO closure device.
- Keith Lurie (University of Minnesota) received $2.8 million as the founder of Advanced Circulatory Systems, which was purchased by Zoll. The company developed a non-invasive, circulatory therapy to boost circulation in hypotensive conditions like shock.
- Jasbir Sra (Aurora Health Care) received a $2 million royalty payment from Medtronic related to ablation.
- Eduardo De Marchena (University of Miami) received $1.6 million for his ownership stake in Tendyne Holdings, which is developing a transcatheter mitral valve replacement prosthesis. Joseph Martin Smith (Rancho Santa Fe, California) received $1.4 million from Tendyne and Lucian Lonzonschi received $1.2 million.
- Klaus (Peter) Rentrop received $1.36 from Spectranetics for a laser atherectomy catheter.
- Sanjay (Jay) Yadav, received $1.234 million from St. Jude following its purchase of the company he started, CardioMems. (Last year Yadav received $23 million and was the top recipient in the list.)
Background, Methodology, and Limitations
By way of background, as required by the Sunshine Act, CMS recently updated its Open Payments database to include industry payments to physicians for the year 2015. The database, which started in August 2013, now covers nearly $16.77 billion dollars of payments, including $6.25 billion in general payments and $9.49 billion for research.
Like many of my readers I’ve wondered how cardiologists fit into this story. Unfortunately, although the Open Payments Website and the ProPublica Dollars for Docs project 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. He 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. The result is a spreadsheet that lists the total amount of payments to any healthcare provider in a cardiovascular specialty.
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 nearly $700 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.