Wednesday, October 01, 2014

Walking around money

It's been a long time since I wrote about the extremely close relationship between the University of Illinois Chicago, its surgical faculty, and Intuitive Surgical, the manufacturer of the daVinci robot.  I am drawn to do so again by the publication yesterday by CMS of the Open Payments database, showing payments from manufacturers to doctors and hospitals.  The presentation demonstrates the remarkable number of payments ISRG has made throughout the country in support of its robotic surgery devices. UIC is just one of many beneficiaries.

As noted by Charles Ornstein at Pro Publica, though, this database is by no means complete. He points out:

* The data doesn’t cover all payments.
The Physician Payment Sunshine Act, part of the 2010 Affordable Care Act, called for the first public release of this data 18 months ago. But because of delays writing detailed rules implementing the law, the first release of data will happen today and it will only cover payments for a few months, from August to December 2013.

* By design, some data on research payments won't be included.
The Sunshine Act allows drug and device companies to delay the publication of data related to research of new products or, in some cases, new uses for existing products. The payments won't be made public until the product is approved by the Food and Drug Administration, or four calendar years after the payment was made, whichever comes first. It is unclear how much money is involved, but, again, just because a doctor doesn't show up as receiving a research payment doesn't mean he or she hasn't received one.

* Because of errors, additional data isn't being released.
CMS has acknowledged that one third of the payment records submitted by companies for last year had data problems that could lead to cases of mistaken identity. The names associated with those payments won't be released today. Federal officials are asking companies to recheck the data, which should be released publicly next year.

With these limitations is mind, I went to the database and filtered the entries by name of company--Intuitive Surgical--and there are thousands of entries.  I then ranked them in descending order.  Most recipients were hospitals, but some were individuals.

Many doctors and hospital received payments for "education"  or "services other than consulting, including serving as faculty or speaker at venues other than a continuing education program."  One of the top recipients in these categories is the University of California, with a total exceeding $600,000.  There were some large items, $175,000 and $100,000; but most of the 79 entries were in the range of $3000 to $6000 payments.

No doubt it is coincidental that the surgery department at UC Davis presents this website parroting unsupported assertions about robotic surgery's benefits to patients.

Another is Houston's Methodist Hospital, which received over $200,000 in the "education" category.

Again from their website, we see the misleading comparison of robotic surgery to open surgery, but no mention of the relative value of manual laparoscopic surgery.

In all, there are almost 17,000 payments from ISRG from this five-month period.  Some are pennies for reimbursements, but almost 1600 are in the range of $2000 to $10,000.  Where are the recipients?  Baltimore, Philadelphia, Tampa, Atlanta, Phoenix, Miami, New York, Loveland, Reno, Newark, Kissimmee, Lansing, Austin, Orlando, Basking Ridge, Greenville, Owensboro, Detroit, Brooklyn, Ypsilanti, Kirland, Menomee Falls, Mt. Clemens, Hialeah, Bemidji, Tulsa, Blue Ash, Sarasota, Patchogue, Jackson, Plains, Cincinnati, Columbus, Jonesboro, Oklahoma City, Novi, Minneapolis, Shelby Township, Pittsburgh, Eau Claire, Green Bay, Denver, Appleton, Jupiter, Kansas City, Las Vegas, Gainesville, Wausau, Rochester, North Little Rock, Milwaukee, and dozens more.

In the old days of politics, we would have called this "walking around money," sprinkling beneficence to engender widespread support and loyalty.

Let's get back to Illinois.  Right near the top of the CMS list was the UIC's Pier Giulianotti.  According to CMS, he received two payments of $50,000 each in cash or cash equivalents as "grants" for the Clinical Robotic Surgery Association.  What's that?  According to its website, it is a "new society devoted to the minimally invasive robotic surgery." It is registered as a not-for-profit corporation.

I couldn't find any mention of Intuitive Surgical financial support on the website, even in Dr. Giulianotti's welcoming letter, but I did find a number of testimonials for the organization from UIC faculty members.  You might remember some of these people from the full page New York Times Magazine advertisement in which the University allowed its name and reputation to be used in support of Intuitive Surgical.

Here's one person from the ad:

Robotic surgery is a constantly evolving field, CRSA website is an invaluable tool to stay up to date.  The platform is easily navigable and is very practical. Information shared on the website includes basic procedures and more complex ones making the site of unique interest for beginners and for expert robotic surgeons. The possibility to assist to entire procedures during the live events is a formidable educational  opportunity to learn from the masters without the need to travel. It's amazing to see how such a large group of surgeons from all over the world is open to share their experiences and work as a group to improve the quality of care and the quality of Surgery.
Francesco Bianco, MD, Assistant professor of Surgery
Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago.

Here's another:

The CRSA represents a common ground where pioneers of robotic surgery coming from various subspecialties work side by side with young, ambitious and promising robotic surgeons. This synergism has created a dynamic and exciting surgical community where masters of robotic surgery share on a daily basis their terrific experience in the operative theater with innovative ideas brought in by young, brilliant individuals that have the potential to be the next generation of robotic surgery innovators.

The website of the association is clearly in line with these traits as it offers a tremendous amount (835 and the number increases each month) of advanced robotic surgery videos presented in a modern looking and easy to navigate internet frame.

CRSA represents for me the ideal place to cultivate and share my passion for robotic surgery and innovation and to provide my contribution for the advancement of the field and therefore I strongly and unconditionally support this association.
Antonio Gangemi, MD, FACS, Assistant Professor of Surgery
Division of General, Minimally Invasive and Robotic Surgery University of Illinois at Chicago, IL, USA.

And another:

Having the opportunity to share the experience from international surgeons has an incredible value for our clinical and research practices. The CRSA website allows surgeons to be connected and integrated allowing to share experiences in difficlut cases.

CRSA has more than 800 videos about diverse robotic procedures, I dont know of any other portal so complete and diverse. Direct communication with other robotic surgeons dealing with similar problems is a powerful advantage of the portal as well.

For any robotic surgeon , experienced or begginer CRSA portal gives extensive material , comments and opinions that improve their clinical experience. CRSA website is also an important communication channel to be informed about upcoming meetings, trainig courses and news of the robotic world. I highly recommend the CRSA website to any surgeon around the world who wants to start a robotic practice.
Enrique Elli, MD, Assistant Professor of Surgery, Associate Director of Bariatric Surgery
Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago.

1 comment:

Josh said...

Methodist Houston has a surgical simulation lab that includes robotic training facilities, which would likely explain the large amount of payments there. UC Davis is likely a similar situation. Robotic training typically involves a two-day, didactic course including animate and inanimate labs (animate labs are expensive), then proctored cases back at the surgeon's home institution.

I'm no big fan of ISRG or robotics in general, but this seems to be the prudent and safe way to disseminate training to the surgical community, and education and training are not cheap.