Open Payments is a federal program, required by the Affordable Care Act, that collects information about the payments drug and device companies make to physicians and teaching hospitals for things like travel, research, gifts, speaking fees, and meals. It also includes ownership interests that physicians or their immediate family members have in these companies. This data is then made available to the public each year on the CMS.gov website.
Applicable manufacturers and GPOs (group purchasing organizations) submit data to Open Payments about payments or other transfers of value between applicable manufacturers and GPOs and physicians or teaching hospitals:
- Paid directly to physicians and teaching hospitals (known as direct payments)
- Paid indirectly to physicians and teaching hospitals (known as indirect payments) through an intermediary such as a medical specialty society
- Designated by physicians or teaching hospitals to be paid to another party (known as third party payments)
In 2016, the total value of open payments was $8,180,000,000, compared to $8,090,000,000 in 2015, $7,860,000,000 in 2014, and $4,090,000,000 in 2013. In 2016, there were 1,146 teaching hospitals with open payment records.
In 2016, there were 631,000 physicians with open payments records, compared to 632,000 in 2015, 625,000 in 2014, and 481,000 in 2013.
In Program Year 2016, applicable manufacturers and group purchasing organizations (GPOs) reported 11.96 million records totaling $8.18 billion in payments and ownership/investment interests to physicians and teaching hospitals. Payments in the three major reporting categories are: General Payments: $2.80 billion; Research Payments: $4.36 billion; and Ownership and Investment Interests: $1.02 billion.
Over the course of the Open Payments program, CMS has published 40.77 million records, accounting for $24.94 billion in payments and ownership and investment interests.
Why was Open Payments begun four years ago? According to the U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services, “We recognize that collaboration among physicians, teaching hospitals, and industry manufacturers contributes to the design and delivery of life-saving drugs and devices and we received many comments supporting this statement. However, as discussed in the proposed rule and in the public comments submitted, payments from manufacturers to physicians and teaching hospitals can also introduce conflicts of interest that may influence research, education, and clinical decision-making in ways that compromise clinical integrity and patient care, and may lead to increased health care costs.”
According to ProPublica, the 10 drugs for which companies spent the most in payments to physicians in 2015 (teaching hospital payments not included) were blood thinner Xarelto ($28.4 million), rheumatoid arthritis drug Humira ($24.9 million), diabetes drug Invokana ($20.9 million), hepatitis C drug Viekira ($19.2 million), blood thinner Eliquis ($18.8 million), diabetes drug Bydureon ($18.5 million), testosterone drug Androgel ($15.3 million), thyroid drug Synthroid ($14.7 million), synthetic hormone Lupron ($14.3 million), and diabetes drug Victoza ($11.9 million).
ProPublica combined previous payment data with prescribing data from the federal Medicare program and found that physicians who receive payments from the industry tend to prescribe more brand-name drugs than those who don’t. Several academic studies reported similar findings.
ProPublica also reported that companies continue to work with thousands of doctors who have received disciplinary sanctions against their licenses.
In a press release entitled “AMA Statement on Newly Released Open Payments Data” dated June 30, 2016, the American Medical Association stated:
“The American Medical Association (AMA) remains committed to transparency and the availability of information for patients to make informed decisions about their medical care. To accomplish this goal, Open Payments data released by the Centers for Medicare and Medicaid Services must be valid, reliable, and complete.
While we appreciate the efforts of the Centers for Medicare and Medicaid Services (CMS) to verify the data submitted by industry, continued data errors and registration challenges during the previous two years have thwarted many physicians from participating in the review and validation process. The integrity goals of the Open Payments database will not be met as long as physician review is obstructed by a registration procedure that is confusing, time consuming, and overly burdensome.
Patients deserve to have access to accurate information. Publishing inaccurate data leads to misinterpretations, harms reputations and undermines the trust that patients have in their physicians. It can also discourage research and care delivery improvements that benefit patients.
The AMA strongly opposes inappropriate, unethical interactions between physicians and industry. However, not all interactions are unethical or inappropriate. There are relationships that can help drive innovation in patient care and provide significant resources for professional medical education that ultimately benefits patients.
We look forward to continuing our working with CMS to improve the Open Payments system to ensure the data is presented in an accurate and informative way to help patients understand and interpret the information correctly.”
An important question that should immediately come to the minds of all U.S. patients seeking medical care from physicians is, “How can I be sure my doctors are making the best medical decisions for me regarding my medical care and treatment when they may be influenced by financial conflicts of interests arising from payments and other lucrative benefits they receive from drug companies and medical device companies?”
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