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Muted reaction to revelations of the Physician's Sunshine Act
There are undoubtedly some landmines yet to be uncovered in the data CMS presented this week in the long-awaited Open Payments program, the legislation (part of the Affordable Care Act) that mandates revealing payments—by dollar amount--to physicians and healthcare organizations—by name—coming from pharma and med device companies. AMA, PhRMA and others sent repeated communications to CMS to hold off the program, but the site went live as scheduled on Sept. 30.
What wasn’t announced—huge sigh of relief here—is a list of life sciences companies who were unable to comply with the deadlines set by CMS for reporting. A significant amount of information was redacted (individual physicians were not identified); but CMS is not calling out companies by name for noncompliance.
Overall media reaction was muted. Pro Publica, the public-interest media company that has run the “Dollars for Docs” program for several years (based on the relatively few pharma companies who have already been providing public information on their payments), made these points in their initial reporting:
* As predicted, the data is messy and not easy to analyze
* Even more data was redacted than the government had said there would be
* Companies spend a huge amount of money on royalty payments
* Medical doctors and teaching hospitals dominated
* Doctors travel a lot, courtesy of drug and device makers
When CMS opened the site, it noted that 40% of the records were redacted because of incomplete information; many of these redactions were initiated by healthcare professionals themselves who questioned the payments they were being credited for. “More than 26,000 physicians and 400 teaching hospitals registered in the Open Payments system to review payments attributed to them,” noted CMS in its news release. And one could look at Pro Publica’s third point—that pharma makes a lot of royalty payments—as proof that both the US R&D environment, and the business practices of Big Pharma, are a positive force in healthcare advances. There are smart docs out there, and the pharma industry pays them for their innovations.
October 2’s Wall St. Journal article (registration required) on the program, "Payments Reveal Range of Doctors' Ties with Industry," dug out a number of doctors who received more than an average amount of money from industry; in one case, the physician’s employer was being paid to conduct three clinical trials; in another case, royalties are going from Cook Medical to a professor of surgery at the University of California, San Francisco, for a stent graft that “it sells around the world”—and that the royalties do not include use of the device by the surgeon’s own patients. All in all, CMS recorded nearly $3.5 billion, in 4.4 million transactions, for the five-month period August-December 2013.
The other point worth noting is that both industry’s and HCPs’ practices have changed during the time leading up to the site’s opening. Industry reports are that physician speaking engagements have declined in the past year or so. CMS says it will be refining and adding to the site on an ongoing basis, and the next iteration of the database, next spring, will have additional information and more detail; but overall, there may be more benefit to life sciences companies themselves, in a better ability to track where their spending is going, than to payers of healthcare services who question the objectivity of HCPs in the drugs they prescribe and the devices they use.