UCSD Study Adds Context To Physician Payments From Biomedical Industry
The initial data gleaned from the Open Payments database, a provision of the Physician Payments Sunshine Act (PPSA), suggests that physicians who practice medicine with the greatest amount of intervention — cardiovascular specialists, neurosurgeons, and orthopedic surgeons, for example — receive the highest value of payments from the biomedical industry. By identifying how industry payments were distributed among physicians, researchers aim to put these financial relationships in context.
As part of the PPSA, which passed into law as part of the Affordable Care Act, drug and device manufacturers report once a year to disclose how many “transfers of value” their companies provided to physicians for items including gifts, speaking fees, meals, travel, and research grants. By creating an atmosphere of transparency surrounding these relationships, policymakers intend to reduce fraud and expose any potential conflicts of interest, which could impact patient care.
In July, a federal government report revealed that the industry paid out $6.49 billion to doctors and teaching hospitals in 2014. Information regarding how much went where is available for free to the public at a Centers for Medicare and Medicaid Services (CMS) website, called the Open Payment Program.
The open availability of this information sparked some concern from industry advocates that information provided without proper context could compromise physician willingness to engage with the industry and could stifle innovation. Researchers from the University of California, San Diego Medical School (UCSD) have conducted a study — published in the Mayo Clinic Proceedings — to analyze the initial data collected by the PPSA and to determine what specialties receive the highest payments.
The study, led by Jona Hattangadi-Gluth, analyzed 2.4 million payments, totaling $475 million, made in the last five months of 2013. Internal medicine and orthopedic surgery received the most money overall ($111M), but surgeons specializing in cardiology and neurology represented the largest proportion of doctors receiving payments. This is likely, said Hattangadi-Gluth, because of those doctors’ dependence on surgically implanted devices.
“Certain specialties, like surgery, may require more research and involvement in device development, resulting in higher royalty and license payments. Our study not only identified how industry payments are distributed by specialty, it also helped put those payments in context,” said Hattangadi-Gluth, in a press release.
In a video produced by Mayo Clinic Proceedings, Hattangadi-Gluth emphasized the need for specialty-specific context when examining these numbers. While physician/industry relationships played an invaluable role in treatment innovation, some conflicts of interest could negatively impact patients and drive up the cost of healthcare.
“Certainly, it is important for us to use Open Payments to understand the nature and extent of these financial relationship, as this was the intent of the Sunshine Act. Further studies which incorporate quality and utilization data will help improve our understanding of these industry/physician financial relationships and how they may affect the healthcare system,” said Hattangadi-Gluth, in the video.