CMS launched Open Payments on Tuesday. Instead of stories entitled “Find Out How Much Your Doctor Makes From Industry!” the media surrounding the release has for the most part focused on the deficiencies in the roll out of the system.
- So Much For Transparency, Open Payments Database Toggles the Mind, Wall Street Journal
- Another Government Website Rollout That Is Found Wanting, New York Times
- Doctor Payments Show Little Value at Launch Time, USNews
- Open Payments Site Launches to User Complaints, Media Health Leaders
Essentially, the physician-level information in the database has too many holes for news outlets to use in a meaningful way. The data covers 5 months (August-December 2013), and more than half of the payments are “de-identified,” meaning that the connection between manufacturers and particular doctors is missing for now. Furthermore, the database was unusably slow the first day, and even now is far from user friendly.
Even more concerning, Wall Street Journal reports that the highest paid physician research recipient was actually mislabeled in the database. GlaxoSmithKline reported over $1,000,000 to Stuart Winter, the vice chair for pediatric research at the University of New Mexico. However, GSK actually gave that money to the National Cancer Institute. A spokeswoman for the company stated: “[a]ttributing the payment to Dr. Winter was an error in the data we submitted to CMS in July, but we corrected and resubmitted the data to CMS in September." WSJ reports the spokeswoman stated that CMS is not using any data submitted after July, “so unfortunately, this error has been posted." She noted the payments were used to cover the cost of the drug being studied.
Open Payments Data
Despite issues with physician identification, there is some useful information to be gleaned from the Open Payments database. Yesterday we broke down research payments by manufacturer and state.
We have provided an overview of other outlets that have provided insight into the data:
Our First Dive Into The New Open Payments System: ProPublica walks through their initial experience with the system, and breaks down a number of interesting charts from the database, including:
Manufacturer General Payments Breakdown
Time Magazine Doctor Search Tool: Time Magazine developed a doctor search tool and provides a chart of the top physicians who received more than $1,000,000 according to the database, which included ten orthopedic surgeons:
While the reason for the prominence of orthopedic surgeons at the top of the list varies for each doctor, orthopedic surgery often involves cutting edge devices for things like knee and hip replacements, many of which are exceedingly expensive. In some cases, doctors are receiving thousands of dollars in royalties for these devices because they have a stake in the intellectual property rights. (This is separate from owning part a stake in the company itself, which is reported separately.)
Highlights From First Open Payments Data Set: Medispend provides a high level look at the Open Payments data that was successfully associated with specific physicians or teaching hospitals.
Articles Highlighting Context in the Database
Payments Reveal Range of Doctors' Ties With Industry: The Wall Street Journal does a great job explaining the variety of collaborative interactions between industry and physicians. They also effectively highlight the problem of just skimming over the highest paid doctors. "Many of the biggest sums paid to physicians didn't involve patient care," the article states.
The authors found a 68-year old doctor who received close to $250,000 in consulting fees, according to the database. The doctor actually retired from practicing medicine in 2010, and devotes his time to consulting with a number of companies on projects "like helping write Lasik machine software for use in cataract surgery." Thus, the payments have no way of affecting his prescribing--he doesn't have any patients.
"Royalties from industry account for a significant portion of the listed payments," the article also notes. According to the database, a surgeon and professor of surgery at UC San Francisco received $2.3 million in royalty payments. The surgeon said the "payments were from Cook Medical for an invention it used in a stent graft device it sells around the world," states WSJ. Furthermore, Cook doesn't pay the doctor royalties when he uses the device on his own patients. The article notes that this particular doctor's work "helped transform aneurysm surgery, benefiting tens of thousands of patients," and that the doctor gets "a small percentage of  stent graft sales in exchange for licensing some of his inventions to Cook."
WSJ also states that the payments attached to one of the top doctors in the "nonconsulting compensation" category of Open Payments actually represent all of the money the doctor's company got for conducting three clinical studies. Furthermore, thousands of dollars under "travel and lodging" for another doctor mostly represent air fare to and from Japan to speak about his research in hypertension medication.
Things to Consider When Searching in Open Payments: We break down seven aspects of the Open Payments database that you may have not considered when first searching for a doctor's name.
One Doc Shoulders Aside Criticism of Sunshine Database: The Wall Street Journal profiles Texas surgeon Stephen Burkhart, who received $7.4 million from a medical device maker. “Burkhart is a pioneer of minimally-invasive shoulder surgery,” states the article. “The way he describes it, his work is a reason why repairing your torn rotator cuff no longer requires opening up your shoulder.” WSJ notes that his work has cut infection rates to less than .01% from 2%.
The article states that the company, Arthrex, pays Dr. Burkhart royalties when other doctors use products made from his inventions, but not when he uses Arthrex products on his patients.
Life Changing Innovation: This website provides information on many specific benefits of physician-industry interactions.
Open Payments May Breed Litigation
Litigation, Risk to Reputation May Come From Scrutiny of Doctors' Payment Data, Bloomberg examines the potentially "wide-ranging effects on both physicians and drug and device manufacturers," from the database, including an increase in qui tam filings under the False Claims Act, as well as the potential for reputational risks to physicians. Elizabeth B. Carder-Thompson, an attorney with Reed Smith, told Bloomberg: “I'm concerned the profit incentive, coupled with data with no context, will lead to more frivolous lawsuits.”
Another attorney mentioned in the article believes the Open Payments data will be viewed infrequently by consumers, and more often by media, government enforcement agencies, and payers. The attorney notes that the potential for data mining has already had a chilling affect on collaborative relationships.
We will continue to follow the Open Payments discussion, and will provide further analysis of the online database.