Sunshine Act Data Reveal Low Payments to Ophthalmologists

Diana Swift

March 20, 2015

"Ho hum" is one ophthalmologist's description of industry-reported data on payments to ophthalmologists. "The payments were generally lower than I expected. Some physicians got a lot of money, but a lot got a $10 sandwich," Michael Repka, MD, a professor of ophthalmology at Johns Hopkins University in Baltimore, Maryland, told Medscape Medical News.

Jonathan S. Chang, MD, a specialist at New York City's Edward Harkness Institute of Ophthalmology, analyzed data for the period between August 1, 2013, and December 31, 2013, posted on the publicly accessible website of the Centers for Medicare & Medicaid Services. The reporting was mandated by the Physician Payments Sunshine Act as part of the Affordable Health Care Act.

Dr. Chang published the results of his analysis in the April issue of Ophthalmology. Dr. Repka was not involved in the study.

As many as 94% of US physicians are estimated to have ties to drug and medical device manufacturers. In the interests of transparency and avoiding undue industry influence on physicians, the required disclosures are intended to reflect any transfer of value from companies to physicians, whether it is cash, meals, entertainment, gifts, stock, travel, accommodation, or other emoluments. Physicians have the option of disputing payments they deem erroneous, but according to Dr Chang and Dr Repka, few seem to bother.

For Dr Chang, the impetus for his study was simple: "I've always been interested in finding out how industry and physicians relate," he told Medscape Medical News. "It's an important relationship of ideas and development. But there's a perception that this money could be influential, and so I wanted to know how much money we were talking about." Research has shown that even small promotional items from industry such as logoed pens can influence prescribing, and reports of how patients feel about physician involvement with industry vary.

Dr Chang's examination of the data yielded little clarity. "It's not clear what this reporting means, because it's relatively hard and time-consuming to verify payments. I'm not sure whether physicians have taken the time to look into this, and no patients have come to me saying they have," he said. So if the purpose of the act is to identify inappropriate relationships, "I'm not sure you can really do that from this information," he noted.

Dr Repka, who is also medical director for governmental affairs at the San Francisco, California–based American Academy of Ophthalmology, agreed. "I don't know the magnitude, but substantial data, which has to go from the field up to corporate and then be dumped into Medicare, was considered inaccurate, and was therefore not reported. And I don't think many physicians have bothered to dispute anything." Further clouding the picture, said Dr Chang, is that drug samples given to physicians are not reported, nor are payments to hospital residents.

Dr Chang's analysis looked at the data by ophthalmologist identification number across 14 categories of payment and four geographic regions and compared them with those for dermatology, neurosurgery, orthopedics, and urology. Supporting Dr Repka's "ho hum" dismissal, most single payments to ophthalmologists were less than $100, and 88% of the physicians received less than $500 in total payments, with the largest expenditures going to a small number of physicians. About a fifth of payments were listed as no more than $10, and 72.6% as less than $50.

During the 5-month period, a total of 55,996 individual payments were made to 9855 ophthalmologists, for a total of $10,926,447. That translated into a mean amount received in a single payment of $195.13 (range, $0.04 - $193,073). The mean amount received per physician was $1108 (range, $1 - $397,849). Dr Chang found no payments flagged as under dispute. Some payments could well be open to dispute, however; for example, if a company took the entire staff of a clinic out to dinner but the entire amount was credited to the principal practitioner. "In some cases, a single individual was being credited with payments, but the whole practice was getting them," said Dr Repka.

Overall, consulting fees made up the largest payment category (42%), at $4,588,395, followed by nonconsulting services such as teaching or speaking at non–continuing medical education events at $1,686,316. Coming in at $3313, the mean consulting fee was much higher than the average payment overall. Food and beverage came in at $1,610,832 total, travel and lodging at $1,177,555, and royalty/license at $964,046. The smallest categories were entertainment and current or prospective ownership/investment interest, at $2463 and $2588, respectively.

Payments did not differ greatly by geographic region, nor did mean and median payments per ophthalmologist differ much from those made to other surgical subspecialists. The highest average payments went to the Midwest, and the highest total distribution was in the South, where the two largest payments (both close to $200,000) were made to the same physician in the royalty/license category, according to Dr Repka.

In comparison, mean payments for dermatology, neurosurgery, orthopedic surgery, and urology ranged from $954 to $6980, and median payments in each field by physician identification number ranged from $88 to $173.

Analyzed according to drugs or devices, the largest payment distribution was for ophthalmic medications ($5,203,332), followed by ophthalmic miscellaneous at $2,770,817 and ophthalmic surgery at $2,422,146.

Dr Chang writes that because the data are limited to a short, 5-month period, "it is not known if this can be extrapolated to a full year." Dr Repka looks forward to full-year data for 2014 and thinks companies need more time to refine their reporting process to improve accuracy.

Ultimately, Dr Chang told Medscape Medical News, "just how such publicly available disclosures will affect medical care and costs and patients' perceptions of their doctors' impartiality warrants further study." He added that apart from direct value transfers, industry can also influence physicians via advertising and sponsorship of medical meetings.

For his part, Dr Repka is not too worried about the potential for such information to be misinterpreted to the detriment of the relationships between physicians and industry and physicians and patients. "Transparency is a good thing for patients and for doctors," he said. "But without the industry interaction, collaboration, and payments to which the data refers, many advances and innovations in healthcare would not have happened at the speed they did."

This study was supported by a grant from the National Institutes of Health and also by Research to Prevent Blindness, Inc., and Columbia University. Dr Chang and Dr Repka have disclosed no relevant financial relationships.

Ophthalmology. 2015;122:656-661. Abstract


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