Physicians should validate their industry financial relationships with CMS

ByScott D. Boden, MD

CMS coordinates public reporting of financial relationships between physicians and industry. The Open Payments Program began in 2007 with the Physician Payments Sunshine Act and became law in 2010 as part of the Patient Protection and Affordable Care Act. The act requires manufacturers of a drug or device reimbursed by any of the public health system programs to report on all transfers of value (cash or other) to physicians and academic medical centers. The first data set from the second half of 2013 was released publicly in September 2014.

Scott D. Boden

The premise behind the effort was to help identify physicians’ potential conflicts of interest in research and product usage decisions. Most societies and medical journals enhanced their conflict of interest reporting and transparency even before this effort.

Public database

The Open Payments database provides publicly available data about physician financial relationships with industry. Unfortunately, the data are listed as a myriad of individual payments and cannot be easily organized or understood. Studies of spine surgery patients have indicated that patients actually think more highly of their surgeon if they have a compensated relationship with industry or have designed products. Thus, one must wonder who really accesses the public database and why. It is unlikely to be individual consumers or patients.

The two specialties with the highest payments were orthopedic surgery and neurological surgery and, undoubtedly, spine and joint replacement were the largest subspecialties. Approximately 25% of the total dollars were paid for consulting fees, speakers fees and travel, while 75% of the physician payments were for royalties or licenses. About 50% of orthopedic surgeons and 80% of neurological surgeons had reported having financial relationships. The mean payments per physician were more than three times higher in orthopedics and neurological surgery than in other specialties, such as urology and plastic surgery, which are largely driven by royalties and licensing payments.

Early concerns

Although the process is relatively new, there are some major concerns in the early going. These include the quality of the data and the review process physicians had the opportunity to pursue prior to the data being publicly released. CMS noted 40% of the records needed to be de-identified because of “concerns about data accuracy.” Less than 10% of physicians have registered with CMS to review and dispute their reported relationships. Earlier this year, of the nearly 40,000 disputed records, about 30% were inaccurate and corrected, 45% were verified as correct and the remaining 25% of disputed records are unresolved.

Financial transparency of physician industry relationships is here to stay and is the law of the land. Physicians, industry and others should recognize that data accuracy, clarity of presentation and the dispute system will need to evolve. Moreover, physicians with significant relationships should register with CMS to review and dispute their data before they are publicly released.

While I am still unsure how and for what purpose these data will be used, I am not convinced this effort is improving patient care or public trust in any meaningful way. In many medical specialties, the relationship between physicians and industry is critical to advancement of patient care and the development of new technologies. If transparency is the price of continued ethical collaboration, then I am sure we all agree this effort is worth it.

For more information:
Scott D. Boden, MD, is the Chief Medical Editor, Orthopedic Surgery, for Spine Surgery Today. He can be reached at Spine Surgery Today, 6900 Grove Rd., Thorofare, NJ 08086; email: spine@healio.com.

Disclosure: Boden reports no relevant financial disclosures.