Physicians self-report payments from members of the pharmaceutical and medical device industries at an average rate of 40 percent; however, many of the lower rates are for providers who have fewer contacts with fewer patients. According to a study published in the Journal of General Internal Medicine, 65 percent of patients saw a provider who had received industry payments in the previous 12 months. Additionally, almost no patients know that the provider had received such payments, despite the information being publicly available.
Physician Payments Sunshine Act
Section 6002 of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), known as the Physician Payments Sunshine Act, increases transparency of physician ownership and investment interests by requiring the disclosure of payments made to providers. Such payments include consulting fees, honoraria, gifts, food, entertainment, charitable contributions, and other transfers of value. This information is reported to CMS, and published online at https://www.cms.gov/openpayments/.
The purpose of this provision was to make patients aware of payments their providers received which may influence the provider’s decision-making process. However, the study notes, if patients are unaware that this information is available, they cannot make informed decisions.
Open Payments data
According to the Open Payments data, the prevalence of industry payments among physicians is around 40 percent, with variation across specialties ranging from 20 percent (pathology) to 80–90 percent (cardiology and orthopaedics). Exposure of patients to doctors who receive payments, however, is not measured by the data. As a result, individuals may incorrectly interpret the data to believe that they have a lower chance of visiting a physician who has received payments than they actually do. If patient contact with physicians who receive payments is significantly higher than the overall average, it would show that industry payments reach more patients than expected.
The study, the first of its kind, took a population-based approach to estimating the reach of industry payments. It used a nationally representative survey to ask patients about their knowledge of the Open Payments data and about the physicians they most often visit. The researchers then linked the physicians named with the data using National Provider Identifiers (NPIs) to determine patient-based industry exposure.
In the subgroup of respondents for whom the researchers could identify providers–matching 1971 physicians to 1987 respondents–the study found that 65 percent of patients, or almost two-thirds, visited a physician who had received industry payments, a much higher percentage than the 40 percent of physicians overall who receive such payments. The highest rates were among patients who visited orthopedic surgery physicians, with 85 percent of patients seeing an orthopedic surgery physician who received industry payments. In addition to patients visiting doctors who received payments at a higher rate than overall physician payment rates, the physicians that patients frequently visited who received payments, received amounts greater than were typical of physicians reported in Open Payments.
Patients reported some level of knowledge of industry payments to physicians, with 45 percent being aware that such payments are sometimes made. However, only 5 percent of patients knew whether the physicians they visited had received industry payments. Most believed that their providers had not received any payments, but 41 percent of them were incorrect.
Overall, the study found that although a minority of physicians accept industry payments, physicians who accept payments are caring for 65 percent of the adult patient population, while very few of the adult patient population is aware of industry payments or possible conflicts of interest.