AMA Studying Tokos Medical Pay to Doctors : Medicine: Ethical questions raised by compensation for referrals of patients for firm’s prenatal care programs.
The American Medical Assn. is looking into a health-care company here that offers to pay doctors who refer patients.
Tokos Medical Corp. provides at-home health care to women with troubled pregnancies. In a letter it sent earlier this year to what Tokos says was a handful of Colorado and Utah doctors, the company offered to pay them from $100 to $200 for each of six types of Tokos prenatal care that the doctors recommended.
In the same letter--which was released to reporters by the AMA--Tokos also offered to provide doctors a nurse once a month to review patient records and identify pregnant women who could be referred to the company.
The AMA’s ethics committee will discuss the payments at a meeting Friday. Paying for referrals is a major ethical issue in medicine today.
The AMA said its officers were on the way to Nashville, Tenn., for the association’s semiannual meeting and could not be reached for comment.
Tokos said Tuesday that it estimates that fewer than 100 doctors nationwide are being paid for referrals. And, it said, it might consider dropping the program if the AMA finds it unethical.
The AMA sent a letter to the company in October saying that the payments might unfairly influence doctors to refer patients to Tokos rather than to its competitors, or to recommend other types of therapy entirely.
The AMA said in its letter that it supports reimbursing doctors for “genuine services” but that the money should come from the patient or the patient’s insurance company to prevent favoritism.
The letter’s author was David Orentlicher, an AMA lawyer for ethics and health policy. He also wrote that the AMA was “very concerned about the breaches of patient confidentiality” entailed in Tokos’ offer to have its nurses scrutinize patients’ records.
Tokos Medical, meanwhile, says it is merely reimbursing doctors for the expense they incur in referring patients. In its letter to the doctors, the company says it “recognizes (that) when a physician prescribes home care services for his patients, it often requires a significant investment of the physician’s time to consult, coordinate and review patient programs.”
The letter continues: “While there is no conventional reimbursement mechanism for these efforts, Tokos recognizes the value of these cognitive services and proposes to compensate the physician. . . .”
Tokos said it paid less than $22,000 last year to fewer than 40 doctors. While it doesn’t have an estimate of how much it has paid this year, the company said, payments may have gone to as many as 100 doctors.
Tokos, which had $126 million in sales last year, said it offers reimbursement only when doctors ask for it.
“A physician says, ‘Hey, I have to spend time dealing with your company and don’t get paid for it. I need to be compensated,’ ” said Jeffrey B. Larkin, Tokos general counsel.
“It’s a small, small portion of our business. Certainly our intent was not to violate any ethical standard the AMA may have.”
Tokos provides machines that monitor pregnant women for signs of premature labor. It also provides drugs to inhibit labor.
The company had other brushes with controversy earlier this year, and its stock has since jumped up and down.
In August, a committee of the American College of Obstetricians and Gynecologists said that Tokos’ monitoring devices have not prevented premature births in high-risk pregnancies.
The company said that the monitors are only part of its treatment program and that blaming the monitors for premature births is akin to blaming thermometers for infections.
A month earlier, in July, a report in the New England Journal of Medicine said a drug similar to one commonly used in the company’s treatment program to slow premature labor is ineffective.
The federal Food and Drug Administration later ruled that the drug criticized in the report, ritadrine, is effective.
More recently, Tokos’ stock took a dive after the company said in November that its fourth-quarter profit will probably be less than stock analysts’ projections.
For the third quarter, Tokos earned $2.5 million on $44.4 million in sales, up from a profit of $2.3 million on $32.7 million in sales for the same period last year.
In Tuesday’s trading on the NASDAQ market, Tokos’ stock closed at $16.25 a share, up 25 cents.
