Sunshine Act hasn’t deterred cash payments to docs

THE FEDERAL GOVERNMENT’S Open Payments database has increased transparency on financial ties between doctors and medical companies, but hasn’t had much of an impact on the amount of money changing hands, according to new research.

The proportion of physicians who received at least one payment unrelated to research from drugmakers, medical-device makers or suppliers decreased by 14% to 394,000—from 2014 to 2018, the study published in JAMA found. However, the total value of those payments fell by just 6%. Overall, more than 49 million payments totaling $9.3 billion were made to physicians.

“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 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 some of the biggest declines in payments, at 16%. OB-GYNs saw a 12% drop, while hospital-based specialties and psychiatrists had 15% and 23% decreases, respectively.

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. About 3.4% of doctors received more than $50,000, accounting for 82% of all such payments.

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

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

The Open Payments database was launched by CMS in 2013 under the Physician Payments Sunshine Act to require public reporting of industry payments to physicians and teaching hospitals.

While Open Payments was not intended to deter industry payments to physicians, Dr. Michael Carome, director of the Health Research Group for consumer advocacy organization Public Citizen, 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,” he said.

Primary-care physicians saw some of the biggest declines in payments, at 16%.