Guest Column: Heavy Meddle by Peter Pitts

May 7, 2012 — The American Recovery and Reinvestment Act (aka, “the stimulus package”) provided AHRQ with $29.5 million for a program on academic detailing and the “communication of CER results to physicians.”

One contract, for $11.7 million, went to Total Therapeutic Management (TTM) and is specifically intended for physician outreach and education.

(TTM is a company that focuses on chart abstraction, data mining, and physician and patient education for a predominantly commercial client base – health plans, pharmacy benefit managers, employers, and pharmaceutical companies, etc.)

The goal of this contract is to integrate AHRQ’s comparative effectiveness research, products, and tools into clinical practice through 9,000 on-site, face-to-face visits with clinicians, nurses, health plan formularies, benefit managers, and other healthcare professionals.

I recently interviewed the Barry Patel, the president of TTM.  Here are some snippets from our conversation:

How will the government decide which doctors are to be visited? Will “high prescribers” of on-patent medicines be on a priority list?

TTM’s top priority is “high volume” practices across 150 Metropolitan Statistical Areas (MSAs). So, rather than focusing on offices with disproportionately high negative patient outcomes, the government is directing its efforts against those doctors who are high prescribers – which is a pretty good indicator about what government detailing is all about – decreasing cost rather than improving care.

When it comes to government detailing (at the taxpayers’ expense), what are the metrics for success?

According to Mr. Patel, the only metrics are whether or not a physician says the sessions have been useful and asks the detailer to come back to discuss other topics. In other words, the metrics are subjective and anecdotal – not clinical.

Interestingly, Mr. Patel doesn’t even agree with either the term academic detailing or counter detailing. “We aren’t counter anything. We’re not there to undo anything. It’s not good versus bad. Our visits aren’t details, they’re the beginning of a process.” And, as far as “academic” goes, Mr. Patel uses that term because “that’s the phrase AHRQ uses and placed in the contract. Our people are patient-centered outcomes consultants, PCOCs.” And “his people” are largely pharmacists and nurses.

A former Merck employee, Patel likens his PCOCs more to pharmaceutical company Medical/Science Liaisons (MSLs) than field representatives. “They’re not discussing product-specific information, but the findings of comparative effectiveness studies.”

How does TTM schedule their appointments with targeted physicians?

According to Mr. Patel, when his “outreach experts” phone physicians to request appointments, the fact that the meeting will result in CME credits is always mentioned. Would a pharmaceutical company be permitted to offer such an enticement? Would such an offer be “sunshine-able” under state and federal guidelines? And, if so, why don’t government detailers have to share the details of their valued benefactions?

Interestingly, according to the Accreditation Council for Continuing Medical Education (ACCME), government is exonerated from having a commercial interest. (A commercial interest is any entity producing, marketing, re-selling, or distributing healthcare goods or services consumed by, or used on, patients.)

Our nation’s single largest payer, Uncle Sam, is not deemed to have a conflict of interest when it comes to designing and providing physician CME.

What’s wrong with this picture?

[Editor’s Note: Peter Pitts is president and co-founder of the Center for Medicine in the

Public Interest. This article appeared May 3 on Read more from Pitts on Government Detailing.]