About one million Americans will undergo joint replacement surgery in the next year. Given that, consumers might be interested to know how much money their orthopedic surgeon might be receiving from joint replacement makers. Although some physicians may not receive funding for using a specific maker’s device, some could receive kickbacks as large as a million dollars, despite that a recent federal anti-kickback case targeted such questionable payments.
Beginning in September 2007, a criminal investigation put a temporary halt on the paychecks of several thousand doctors who were also consulting for joint replacement device makers. In a settlement, in which they admitted no wrongdoing, the industry’s “major players” paid $311 million and agreed to federal monitoring. The high-profile prosecution did not sever the financial ties between doctors and medical-supply companies and payouts continue. Some experts fear that between buying out old contracts and writing new contracts under stricter compliance standards, amounts could increase; critics expect patients will face more problems because there is no way in which patients can determine how back-door financing is affecting medical care and choices. Of deepest concern? Doctors using a specific device or procedure for the money they will make, not for the benefits of one device or procedure over another and not for what is in the patient’s best interest.
Such lucrative “side deals” cannot possibly occur with no conflict of interest and according to Rosamond Rhodes, ethicist at the Mt. Sinai School of Medicine in New York, these practices create the potential to distort the judgment of the most well-intentioned doctors. “It’s just human nature,” she said. “The money moves you.” Worse, while money is given to those surgeons who assist in developing new products, industry is augmenting their programs for training and education, which involves flying in doctors nationwide and paying them to teach each other. That’s a glaring conflict, in the view of Dr. Brian Hurley, president of the American Medical Student Association, who believes medical professionals should pay training expenses out of their own pockets. “It’s like going to a car salesman to learn about cars. The point is always, ‘Use more of our product,’” he said. “Patients need to know they can trust that when a physician recommends something for them that it’s in their interest, as opposed to the financial interest of the physicians themselves.”
Between 2002- 2006, Zimmer Holdings Inc. and three of its rivals paid over $800 million to 6,500 doctors, hospitals, and medical associations. In 2007, 48 doctor-consultants received $1 million or more each. Also, spine and heart devices makers have been accused of paying specialists with undeserved patent royalties and strip-club visits. Meanwhile, Zimmer owes nearly $100 million in back pay to doctor-consultants, and will spend millions to buy out old royalty contracts and broker new deals. Device makers paid a “large number of doctors” to increase sales and guarantee loyalty to particular implant brands, according to a spokesman for U.S. Attorney Christopher Christie of New Jersey, who brought the case. Investigators found money and perks, such as luxury trips, were given to surgeons who did little or no work. Prosecutors have said their investigation is ongoing and criminal charges against surgeons who solicited kickbacks are expected shortly.
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