In April, the Centers for Medicare and Medicaid Services (CMS) released over thirty Medicare Part D payment spreadsheets, containing millions of lines of data. Interested patients can download the document containing their doctor’s last name, and find out how often he or she prescribed particular drugs to Medicare patients.
We have speculated for some time now that the trove of Medicare data would be paired with Open Payments data, both by journalists and potentially the government. Modern Healthcare indeed recently published an article correlating the two, entitled “Drugmakers funnel payments to high-prescribing doctors.”
The article includes an interactive tool to search for physicians who prescribed $500,000 or more of a drug and received money from the drugmaker. One such entry is for a doctor who prescribed approximately $600,000 worth of a drug and received $24 from that drug’s manufacturer.
The article also includes a “spotlight on potential conflicts,” which parses out the ten highest-prescribing Medicare physicians who are listed in the general payments database in Open Payments as receiving at least $5,000 from drug companies in 2013.
The article’s takeaway is that “about 23% of the 400-plus providers who prescribed $1 million or more of one drug received money from the maker of the drug.” What is interesting—even taking into consideration the small meals or often vital consulting or education agreements deemed to be “funneling” of funds—is that 23 percent is quite a low figure if you consider that “[m]ore than 90% of physicians report having some type of business relationship with industry sources.” (Modern Healthcare).
The article targets the Open Payments data and prescribing habits of Dr. Vallerie McLaughlin, an expert in cardiovascular disease, and Director of the Pulmonary Hypertension Program at the University of Michigan. She prescribed $4.8 million of the pulmonary arterial hypertension (PAH) treatment, Tracleer, and received $40,000 in consulting, travel, and meal fees from the Tracleer’s manufacturer, Actellion. The article does provide some balance, including quotes from Dr. McLaughlin. “It's in the best interest of clinical-care delivery for biomedical companies to be advised by the knowledgeable, experienced experts,” McLaughlin states. “I have treated PAH patients and have been involved in clinical trials in PAH for 20 years.”
Unfortunately, however, the article and others like it may be a disincentive for experts such as Dr. McLaughlin, who work in a specialized and very important field, to educate their peers on their area of expertise. The article is unclear about who would be better qualified from an academic or professional standpoint to teach others about hypertension treatment.
While there are certainly corrupt doctors who bill Medicare, the article’s implications that high prescribing doctors with payments in CMS’s Open Payments database are inherently unethical seems like the wrong approach. It not only has the potential to undermine the trust of patients in experts in a given specialty (which may lead to patients avoiding important treatments or not taking their medication), it also may silence doctors who should be educating their peers and patients on innovative new therapies.
The article notes that CMS has "cautioned that payments to providers from drugmakers and biotechnology companies don't necessarily mean there is a conflict of interest." The agency states: “Information about financial relationships alone is not enough to decide whether they're beneficial or improper...[j]ust because there are financial ties doesn't mean that anyone is doing anything wrong. Transparency will shed light on the nature and extent of these financial relationships and will hopefully discourage the development of inappropriate relationships.”
With the second year of Open Payments data due out at the end of the month, articles that simply list the top paid doctors will continue to proliferate. However, the impact of industry-physician collaborations--which result in tangible patient benefits--should be similarly easy to communicate.