Last week the federal government launched its long-awaited website tracking the money drug and medical device companies pay to doctors for various kinds of product and research support. But it’s less a new initiative for transparency than a disappointment.
Readers of this blog will recall that the Physician Payment Sunshine Act spawned Open Payments, the first public release of industry payment data, and was part of the Affordable Care Act (“Obamacare”). It was supposed to go live 18 months ago, but was delayed until now, and even with the extra time, tracks payments only from August to December 2013.
According to Open Payments, its database “creates greater transparency around the financial relationships of manufacturers, physicians and teaching hospitals.” The information comes from annual reports made to the Centers for Medicare & Medicaid Services (CMS).
But as reported by ProPublica.org and NPR, the site is “a very limited window into the billions in industry spending.”
When the site launched, the New York Times reported that pharmaceutical and device makers shelled out approximately $380 million to doctors in speaking and consulting fees. Some individuals received more than half a million dollars, and remember — that’s only for the initial five-month reporting period from last year.
Some doctors, according to The Times, earned millions in royalties from products they helped develop.
The Times reported that during those five months, drug and device companies made 4.4 million payments to more than half a million health-care professionals and teaching hospitals for a total tab of about $3.5 billion.
The Times called into question the value of Open Payments, at least for its debut: “[A]bout 40% of the records do not tie back to a specific professional or teaching hospital, accounting for 64% of the overall payments,” the paper said.
Consumers are invited to search the site to find out if their doctors received industry money (and possibly compromised their independent medical judgment) and if so, how much was paid by whom. But before you conduct a search, ProPublica/NPR advises you to keep five things in mind.
1. The data covers only a fraction of payments, from August to December 2013.
If you search for your doctor and can’t find him or her, that doesn't necessarily indicate he or she didn't receive a payment.
Also, those five months’ of data might not represent a company's spending over a whole year. Some companies might concentrate promotional talks, which can reward doctor/speakers handsomely, in the first part of a year, which wouldn't be represented in this data.
Some of these concerns will be resolved by the time the government releases data on payments for the full calendar year 2014, which is expected next summer.
2. Some data on research payments won't be released until the product in question is approved by the FDA, or four calendar years after the payment was made, whichever comes first.
The Sunshine Act permits drug and device companies to delay the publication of data related to research of new products or, in some cases, new uses for existing products. It’s not clear how much money is involved. And, again, just because a doctor’s name isn’t on the list as receiving a research payment doesn't mean he or she hasn't received one.
And the breadth of health-care providers is not represented in the database. Physicians (medical doctors and osteopaths), dentists, chiropractors, podiatrists and optometrists are included. But companies are not required to report payments to nurse practitioners or physician assistants.
3. Some data is being withheld because of company errors that led to cases of mistaken identity.
CMS acknowledged that 1 in 3 payment records submitted by companies for last year had data problems that could lead to cases of mistaken identity. The names associated with those payments were not released last week. Federal officials have asked companies to verify their data, which should be released publicly next year. (See our recent blog, “Feds Withhold Some Information From Doctor Dollars Database.”)
CMS officials discovered the problem while investigating a physician's complaint that payments were being attributed to him even though they were made to another physician with the same name, as we wrote in our blog. Looking into the matter, the feds discovered "intermingled data," meaning that some physicians were linked to medical license numbers or national provider identification numbers that weren’t theirs.
It serves no one’s interests to post inaccurate or misleading information; better to withhold and correct it than present an erroneous database.
4. Not all payments have the same significance.
The listed categories indicate varying levels of involvement with a company, from consulting and speaking fees to research payments, entertainment, travel and lodging and educational items.
Consumers on Open Payments see fees divided into different categories: consulting fees, speaking fees (called "services other than consulting"), research payments, honoraria, gifts, entertainment, food and beverage, travel and lodging, educational items, charitable contributions, royalties, ownership interests and grants.
Those different types of payments indicate different levels of involvement with a company.
Educational items, for instance, include medical textbooks and reprints of journal studies given to doctors. Research payments might include more than the pay somebody got to lead a study. Payments for clinical studies might include costs associated with patient care, supplies, as well as the time spent by health-care professionals treating patients and managing the study.
Educational items that directly benefit patients (such as informational posters) and medication samples do not have to be reported and you won't see their value reflected in the data.
5. This is the first federal release of this data: There will be mistakes.
Although the rollout of Open Payments isn’t as fraught as that of Healthcare.gov, the Obamacare insurance exchange, because it’s not nearly as complex, it's reasonable to expect some glitches. The same company that was responsible for launching Healthcare.gov also is responsible for the release of the payment data.
And drug and device manufacturers make mistakes. For example, doctors with similar names might be confused, so a payment made to one might be attributed to someone else.
The government gave doctors 45 days to review and dispute payments attributed to them before the information becomes public, but it's unclear how many did. Professional and trade groups say that process has been confusing.
The New York Times story illustrated how understanding the database requires more than just a quick look at a numbers tally. “When you look at why do drug companies and device companies make gifts and offer consulting payments and honoraria to physicians, the main goal is to influence prescribing practices,” Dr. Michael Carome told the paper. He’s director of Public Citizen’s Health Research Group. “The interest of those companies is to improve their financial bottom line, and not necessarily represent the best interest of patients.”
But, notes The Times, if some relationships might leave doctors open to scrutiny, other ties promote innovation. “Drug and device makers say they regularly consult with doctors to help them decide where the need is the greatest, and doctors conduct clinical trials that help get products approved,” the paper reported.
“Research, for example, accounted for nearly $1.5 billion of payments during the reporting period. Companies spent an additional $302 million on royalties and licenses, money that is paid to doctors and teaching hospitals for their role in developing companies’ products.
So if you have a question about what your doctor received, if you want to know if he or she has any kind of financial relationship with a medical company, ask him or her.
ProPublica’s Dollars for Docs site has been tracking payments by certain large drug and device companies for four years. It has information from 17 drug companies, which represent about half of U.S. drug sales from last year.
So Dollars for Docs probably has information you can't find on Open Payments. It enables you to search by name, state, company or payment category.