Industry payments to physicians varied widely by specialty during the first half-year of The Centers for Medicare & Medicaid Services’ Open Payments program, found a recent study.1

“For many years, federal policymakers have tried to increase the transparency of industry-physician financial relationships through legislative action,” says Jona Hattangadi-Gluth, MD, the study’s senior author and assistant professor of radiation medicine and applied sciences at UC San Diego Health System.

In 2010, the Physician Payment Sunshine Act was signed into law under the Affordable Care Act. This led to the establishment of the Open Payments program, making data on all industry payments to physicians and teaching hospitals publicly available.

The researchers analyzed the first release of these data, which included $3.7 billion in total value for industry payments made during the latter half of 2013. “These data really need to be interpreted in their specialty-specific context,” Hattangadi-Gluth cautions. Some key findings include the following:

  • Cardiovascular specialists and neurosurgeons were most likely to receive general payments. Pathologists were least likely.
  • Internal medicine physicians and orthopedic surgeons received the greatest total value of payments. “But in internal medicine, this value was split over a much greater number of doctors,” Hattangadi-Gluth notes.
  • Payments were mostly in cash or cash equivalent. “We also found that payment data are quite skewed,” says Hattangadi-Gluth. “There are a few physicians in some specialties who receive very high payments.” This was especially true for orthopedic surgery and neurosurgery, she says.
  • Ownership interest was limited to very few physicians within each specialty. “The median values of these interests, per physician, tended to be on the order of several thousands of dollars,” notes Hattangadi-Gluth.
  • The most common reason for payments were for food or beverage.

“But when we looked at the proportion of total value of general payments, much of these were for consulting, speaker fees, royalty, and license payments,” Hattangadi-Gluth says. The study didn’t examine whether financial relationships that were disclosed are harmful or inappropriate.

“In fact, without critical relationships between physicians and biomedical industry, innovation in healthcare with respect to drug and device development would suffer,” she adds. However, some financial conflicts of interest among physicians may be problematic. “This is especially true if they affect patient care and drive up costs,” says Hattangadi-Gluth.

Now that industry payments are legally required to be reported, it might deter physicians from engaging with industry. “That may or may not be a good thing,” says Hattangadi-Gluth.

The data suggest that specialties with a greater amount of intervention, like cardiology and orthopedic surgery, received a greater value of payments from industry. “This implies a closer relationship with device and drug companies,” Hattangadi-Gluth says.

Another study looked specifically at orthopedic surgeons and found that financial ties were highly prevalent in this specialty.2 A small subset of surgeons received large royalties.

“The most surprising finding of the study, for me, was not necessarily the size of payments to surgeons, but the fact that the vast majority of payments were concentrated in a few surgeons,” says lead author Sravisht Iyer, MD, an orthopedic resident at New York City-based Hospital for Special Surgery.

A small subset of surgeons received large royalties. “This can represent a meaningful interaction with industry that serve to advance the state of the art in the orthopedic science and patient care,” notes Iyer.

Further studies which incorporate quality and utilization data are needed, concludes Hattangadi-Gluth, “to improve our understanding of these industry-physician financial relationships and how these may affect the healthcare system.”

REFERENCES

  1. Marshall DC, Jackson ME, Hattangadi-Gluth JA. Disclosure of industry payments to physicians: An epidemiologic analysis of early data from the Open Payments Program. Mayo Clin Proc 2016; 91(1):84-96.
  2. Iyer S, Derman P, Sandhu HS. Orthopaedics and the Physician Payments Sunshine Act: An examination of payments to U.S. orthopaedic surgeons in the Open Payments database. J Bone Joint Surg Am 2016: 98(5): e18.

SOURCES

  • Jona Hattangadi-Gluth, MD, Department of Radiation Oncology, UC San Diego Health System. Phone: (858) 534-1222. Email: jhattangadi@ucsd.edu.
  • Sravisht Iyer, MD, Hospital for Special Surgery, New York City. Email: IyerS@hss.edu.