Sunshine Act Didn't Deter Industry Pay to Physicians in 2015

July 01, 2016

When the Centers for Medicare & Medicaid Services (CMS) launched its Open Payments program to reveal online what drug and device makers gave physicians and hospitals, the agency thought transparency could "deter inappropriate financial relationships," as it said in a regulatory document.

Whether or not professional conflicts of interest have lessened since the program debuted in 2013, the volume of money flowing from industry to clinicians has not. CMS published Open Payments data yesterday for 2015, showing that drug and device makers gave $7.52 billion in cash, food, and ownership and investment interests to physicians and teaching hospitals. That figure represents a 0.4% increase over the $7.49 billion reported for 2014.

The first full year of industry payments collected and published by CMS was 2014. Data for 2013 cover only the last 5 months of the year.

The consistency from 2014 to 2015 also characterizes, more or less, the major categories of industry spending on clinicians and hospitals. In 2014, so-called general payments that include consulting and speaking fees, food, travel and lodging, and gifts came to $2.64 billion. Those payments dipped slightly to $2.6 billion in 2015. Research payments rose from $3.79 billion in 2014 to $3.89 billion in 2015. The value of ownership and investment interests bumped down a bit from $1.06 billion to $1.03 billion. And in both 2014 and 2015, roughly 618,000 physicians (a group that includes dentists, optometrists, podiatrists, and chiropractors) were on the receiving end of industry largesse.

"These Companies Know They Can Influence Physician Prescribing"

The Open Payments program was created by a provision of the Affordable Care Act called the Physician Payments Sunshine Act. The law requires drug and device makers to report to CMS "transfers of value" of $10 or more to physicians and teaching hospitals. If transfers of value under $10 add up to more than $100 a year, that is reportable, too, as are financial stakes in drug and device makers.

This exercise in transparency was designed to discourage physicians from embroiling themselves in conflicts of interest that might corrupt clinical decision-making, research, and education, as well as unnecessarily increase healthcare costs. However, a physician at the consumer watchdog group Public Citizen told Medscape Medical News that "if there is to be any effect from increased transparency, it will take a long time."

Michael Carome, MD, the director of Public Citizen's Health Research Group, said he is not surprised by the undiminished amount of money flowing from industry to physicians.

"These companies know they can influence physician prescribing," Dr Carome said. "These payments pay off for the companies. And on the provider side, unfortunately, money talks. Physicians are all too willing to accept these gifts and other forms of payment from industry."

As evidence that industry money talks, Dr Carome cited a recent study published in JAMA Internal Medicine. The authors report that a single free meal provided by a drug company can make a physician more likely to prescribe the company's brand-name drug, rather than a less expensive generic. More studies like this, he said, will do more to shame physicians into better behavior than merely posting industry payment figures on the CMS website.

Not All Financial Relationships Are Unethical, Says AMA

CMS suggests that Open Payments is living up to its purpose. Shantanu Agrawal, MD, the agency's deputy administrator and director of its Center for Program Integrity, said in a news release that "transparency is empowering physicians to be purposeful about their financial relationships." Dr Agrawal also noted that drug and device makers in 2015 significantly decreased what they spent on gifts and honoraria and boosted their spending on charitable contributions to physicians and hospitals (by more than 120%, according to an accompanying chart).

The agency cautions that Open Payments data for a physician do not mean necessarily that he or she has a conflict of interest. The American Medical Association (AMA) made a similar point yesterday in its response to the publication of the payment data.

"The AMA strongly opposes inappropriate, unethical interactions between physicians and industry," the association said in a news release. "However, not all interactions are unethical or inappropriate. There are relationships that can help drive innovation in patient care and provide significant resources for professional medical education that ultimately benefits patients."

Since the beginning of the Open Payments program, the AMA has fretted about the accuracy of the data.

"Publishing inaccurate data leads to misinterpretations, harms reputations and undermines the trust that patients have in their physicians," the group said. "We look forward to continuing our working with CMS to improve the Open Payments system to ensure the data is presented in an accurate and informative way to help patients understand and interpret the information correctly."

Follow Robert Lowes on Twitter @LowesRobert

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