Oncologists Are Engaging Less With Industry Since Open Payments

Roxanne Nelson, RN, BSN

June 07, 2019

CHICAGO — Since the inception of the Open Payments program, fewer American medical oncologists appear to be engaging with industry, new findings show.

But even though fewer oncologists are receiving payments, industry spending has not decreased. The dollar value and number of payouts held steady during the study time period, although the number of oncologists who received payments declined.

The average annual per-physician payments from industry increased from 2014 to 2017, driven by increases in consulting fees and compensation for speaking engagements not related to continuing medical education (CME).

There was also a marked increase of payments for accredited CME work, and at the same time, spending decreased for non-accredited/certified CMEs.

"Fewer oncologists are receiving payments, but spending has not decreased, suggesting that physicians are less likely to receive payments and industry is being more selective," said lead author Deborah C. Marshall, MD, a radiation oncology resident at the Icahn School of Medicine at Mount Sinai in New York City. "It seems that more money is being spent on fewer people, so it can also be that oncologists have become more selective as well, and less interested in engaging in less important relationships."

The findings were presented here at the American Society of Clinical Oncology (ASCO) 2019 Annual Meeting.

"We have seen a small shift," she told Medscape Medical News. "But it will take more than just transparency to create any kind of culture change, and Open Payments alone isn’t enough to create broader changes."

Organizations such as ASCO and the American Society for Radiation Oncology (ASTRO) now require full disclosure, and the subject has received a great deal of media attention. "When José Baselga failed to disclose his industry relationships, and eventually had to step down — that had quite an effect on organizations and institutions," she said.

Baselga, MD, PhD, formerly physician-in-chief and chief medical officer at Memorial Sloan Kettering Cancer Center in New York City, resigned last year after revelations by the New York Times and ProPublica about his failure to disclose financial ties to industry.

Less Oncologists, Higher Payments

The effect of the Open Payments program on how oncologists engage with industry is unknown. To better understand how Open Payments affected individual oncologist behavior, Marshall and her colleagues evaluated trends in physician-level payments to test whether the implementation of this program has decreased physician interactions with industry and shifted the nature of interactions toward those considered more appropriate.

They performed a retrospective cohort study that included medical oncologists who were identified from the National Plan and Provider Enumeration System. Data from Open Payments for general payments unrelated to research from 2014 to 2017 were matched to physicians. The percentage of physicians who received payments, the annual value and number of payments, and average annual trends over time were then analyzed.

Of 15,494 medical oncology physicians in the 2014 cohort, 81% received at least one payment between 2014 and 2017. During that span, medical oncologists received 1.4 million industry payments totaling $330.6 million.

The absolute number of medical oncologists who received payments declined by an average of 4% annually (P = .006), and proportionally from 67.2% to 59.6% overall.

However, the value and number of payments did not significantly change; the types of payments, though, shifted during the study period.

The value and number of payments for accredited CME work rose by 821% and 209%, respectively, but at the same time decreased for non-accredited/certified CMEs by 18% and 25%, respectively.

Payments for food and beverage remained steady whereas the value and number of royalty or licensing payments increased.

Increased payments for accredited CMEs suggest physicians are avoiding less appropriate venues, she noted, adding that even though food and beverage payments are not decreasing, these interactions may not be recognized as problematic (although increasing royalty/licensing payments require ongoing scrutiny).

Marshall emphasized that there are positive aspects to industry associations, but "we just need to make sure that it is open and transparent."

"I think it’s worth following these trends, and see if there are continued downstream effects," she added. "Now that people are more aware, it would be worthwhile to continue watching and take another look in a few years."

No Value to Patients

In a discussion of the study, Aaron Philip Mitchell, MD, an oncologist at Memorial Sloan Kettering, noted that this abstract, along with others presented at the meeting, "highlights an important fact about the US healthcare system in that provider interests and patient interests often — but do not always — align."

"In this study, receiving compensation from the drug industry is lucrative but does not add value or help patients," Mitchell said.

The research was granted a 2019 ASCO Annual Meeting Merit Award by Conquer Cancer, the ASCO Foundation. Marshall and Mitchell have disclosed no relevant financial relationships.

American Society of Clinical Oncology (ASCO) 2019 Annual Meeting:
Abstract 6520. Presented June 1, 2019.

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