Open Payments database has little effect on industry payments to doctors

The federal government’s Open Payments database has increased transparency on financial ties between doctors and medical companies, but it has done little to deter those agreements, according to new research.

The proportion of physicians who received at least one non-research related payment from drugmakers and medical devicemakers or suppliers decreased by 14%—from 458,000 to 394,000—from 2014 to 2018, the study published Tuesday in the Journal of the American Medical Association found.

The total value of the payments physicians received from 2014 to 2018 remained decreased by 6% over that time. Overall, more than 49 million payments totaling $9.3 billion were made to physicians over those four years.

“It just suggests that more attention is needed to these types of interactions with industry,” said study lead author Dr. Deborah Marshall, a research fellow at Mount Sinai Health System’s the Icahn School of Medicine, in New York. “We need to understand how we can either engage with industry in ways that are very productive or have greater independence from industry influence and figure out where that can be achieved.”

Primary care physicians saw the greatest decline in industry payments, falling by 16% between 2014 and 2018. Obstetricians and gynecologists saw a 12% drop, while hospitalists and psychiatrists experienced 15% and 23% decreases, respectively.

Medical specialty physicians received 11% fewer payments and surgical specialists had a 9.5% drop.

More than 90% of physicians receiving industry payments accrued less than $10,000, with an average of $438 per physician per year. That figure remained relatively flat from 2014 to 2018. Approximately 3.4% of doctors received more than $50,000 and accounted for 82% of all industry payments.

Medical and surgical specialists received the most in industry payments. Physician specialists received an average of more than $7,000 per doctor in industry payments in 2018, while surgical specialists received an average of more than $10,000 per person that same year.

The study suggests transparency alone may not be enough to stop or even slow down the lucrative flow of money doctors receive from medical companies. While tje arrangements aren’t illegal, the financial arrangements could influence clinical decisions.

JAMA also published a second study Tuesday on the relationship between physicians’ selection of implantable cardioverter-defibrillators (ICDs) and the payments they receive for devicemakers. Patients were more likely to receive an ICD from the manufacturer that provided the highest payment to the physician who performed the implantation.

“There are plenty of physicians out there who have no idea that Open Payments exist,” Marshall said. “While transparency is an important first step, I think interpreting and responding to these data is something that has just started to happen.”

The Open Payments database was launched by CMS in 2013 under the Physician Payment Sunshine Act to require public reporting of industry payments to physicians and teaching hospital to promote, “…a more transparent and accountable health care system…”, according to the agency’s web site.

To that end, the program has fulfilled its purpose, said Dr. Michael Carome, director of the Health Research Group for consumer advocacy organization Public Citizen.

Carome doesn’t believe Open Payments was ever intended to deter industry payments to physicians. He said the database is a helpful tool to develop policies that can address any adverse health outcomes that may result from such ties. “That transparency has been a good thing,” Carome said.