Sunshine Act: Are Doctors Still Enjoying Free Lunches From Drug Reps?

Leigh Page

Disclosures

November 21, 2017

In This Article

Small-Cost Items Must Be Reported

Under a section of the Affordable Care Act (ACA) that mandated the creation of the Open Payments website, any transaction worth $10 or more must be reported on the site. And if the yearly amount exceeds $100, items costing less than $10 must also be reported.

These small-cost items help explain why the Open Payments site lists half a million physicians plus more than 100,000 dentists, dental surgeons, chiropractors, podiatrists, and optometrists.

Most listed clinicians took very little from industry. The median payment per clinician on the site in 2015 was just $157, according to data compiled by staff of the Medicare Payment Advisory Committee (MedPAC) and presented[3] at a MedPAC meeting.

In many cases, physicians got only free lunches or perhaps some free samples, which also have to be reported. Altogether, 96% of listed providers received meals, according to data from the site obtained by Thomas Sullivan, editor of Policy and Medicine. Sullivan, who has a background in organizing industry-sponsored continuing medical education (CME), is one of the leading experts on the Open Payments site.

These small meals add up: Sullivan's data show that the average provider getting a meal got about 16 of them per year. All told, the drug and device industries paid for a total of 9.97 million meals a year, worth almost $250 million. In comparison, physician CME speaker fees cost the industry less than $50 million in 2016.

What Is the Impact of Open Payments?

Are doctors cutting back on their connections to industry, now that Open Payments is publishing them for the whole world to see? In a 2015 survey by MedPanel,[4] a healthcare market research firm, 21% of doctors said their participation in market research had declined since the program had started, but 76% said it had not changed.

The site itself reported slightly fewer providers in 2016—631,000, which was down from 632,000 in 2015, according to data gathered by Sullivan. The 2015 number represented an increase over 2014, when 625,000 were reported.

Sullivan's data showed, however, that the total number of transactions with industry fell in both years. There were 11.96 million transactions in 2016, down 2.84% from 2015, which in turn was a 2.11% decline from 2014.

It's also worth noting that the number of sales reps, who carry out many of these transactions, has dropped considerably. The drug rep sales force has fallen by 35% since 2006, according to a 2016 report.[5]

The decline in reps is due in part to a decline in blockbuster drugs, but also because considerably fewer physicians are willing to see them. According to a report[6] by ZS, which provides physician-access information to drug reps, 34% of physicians' offices were accessible to drug reps in 2016—down from 65% in 2012, before the website was created.

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