More than nine out of 10 doctors at the Hospital of the Fox Chase Cancer Center received payments from drug and medical-device firms in 2014, an analysis of Medicare payments data by ProPublica found.

Its rate of 92 percent ranked Fox Chase highest in the Philadelphia region for the percentage of affiliated doctors accepting payments from pharmaceutical or medical-device firms, the data showed.

Fox Chase, which ranked 10th nationally for its percentage of affiliated doctors receiving payments of any size, also had the region's highest percentage of doctors who collected at least $5,000.

J. Robert Beck, Fox Chase's chief academic and administrative officer, attributed the high overall ranking to the practice of hosting noon conferences with meals provided by pharmaceutical firms.

That was stopped Jan. 1, 2015, Beck said, and even before that there were measures in place to limit the influence of the companies footing the bill.

"They weren't related to the topics being discussed, but we stopped it anyway," he said.

Also in the top five for any level of payments in the analysis by ProPublica, a tax-exempt investigative journalism organization, were Main Line Health's Bryn Mawr Hospital; Mercy Suburban, which has since been sold; Lansdale; and Delaware County Memorial.

In response to the study, the hospitals said they had procedures in place to manage potential conflicts of interest.

Efforts to restrict the influence of the pharmaceutical industry on doctors have been underway for years. Some of the most egregious pharmaceutical-funded perks, such as continuing-medical-education trips to exotic locales, have stopped.

But a growing body of statistical studies, including one published this month, has shown that interaction with pharmaceutical-company representatives - even over a $20 meal - can influence prescribing practices, experts said.

This matters to patients because they can end up with much higher co-pays or deductibles, said Richard Baron, a primary-care physician and chief executive of the American Board of Internal Medicine, in Philadelphia.

In a study published this month in JAMA Internal Medicine, "there was a choice doctors could have made for a less expensive drug that would have been as effective," Baron said. "The doctors who had the meals were more likely to prescribe the more expensive drug."

Pharmaceutical Research and Manufacturers of America, a major trade group, has a voluntary Code on Interactions with Healthcare Professionals, designed to provide a framework educating doctors about products' benefits and risks.

William B. Jordan, immediate past president of the National Physicians Alliance, a tax-exempt education and research group that has advocated for conflict-free medicine, said there were better ways to educate doctors.

If it is not publicly supported, doctors should pay for it themselves, not let industry do it, Jordan said. "Doctors shouldn't expect free education," he said.

Passage of the Physician Payment Sunshine Act as part of the 2010 Affordable Care Act increased public insight into the interactions of pharmaceutical and medical-device manufacturers with medical professionals.

ProPublica has been analyzing pharmaceutical company payments to doctors for six years. Its latest effort matched data on payments to physicians in 2014 with data kept by Medicare on the hospitals that physicians were primarily affiliated with at the time.

The payments in the overall analysis included speaking, consulting, meals, travel, gifts, and royalties for inventions, but not research. Only doctors who participate in Medicare were included.

Some hospitals questioned the data.

Crozer-Keystone Health System disputed the number of affiliated doctors attributed to it, which increased the percentage of doctors receiving payments under ProPublica's methodology.

The University of Pennsylvania Health System said the underlying federal data used by ProPublica sometimes incorrectly classify research grants or royalties for patents as speaking fees.

Low average payments at most hospitals suggest that many of the payments are for conference meals, such as those eliminated last year at Fox Chase.

Penn halted that practice about a decade ago, a spokeswoman said.

Deborah Heart and Lung Center, in Browns Mills, is reviewing the policy on its educational forums with industry-provided meals.

In addition to ranking ninth in the region for the percentage of doctors receiving any payments, Deborah also ranked second behind Fox Chase for the percentage of doctors receiving $5,000 or more.

Deborah said it had "strict policies and rigorous reporting regarding these payments to ensure that its medical professionals maintain high ethical standards and avoid any conflict of interest."

Fox Chase, a cancer-research hospital, has a relatively high percentage of hematologist-oncologists who are leaders or are on scientific advisory boards for pharmaceutical companies, Beck said.

Such activities are encouraged, he said, but they are managed.

"Everyone who hits that $5,000 threshold gets reviewed not only by me, but by my conflict-of-interest committee and a management plan is put in place," Beck said.