Where are the “Open Payments” from Government?

doctor-xray-2Well, now we know how much pharmaceutical companies and medical-device makers pay doctors for consulting and similar services. Paul Keckley aptly summarizes last week’s data dump from the Centers for Medicare & Medicare Services (CMS):

  • In the last five months of 2013, drug manufacturers made 4.4 million payments totaling $3.5B to 546,000 physicians and 1,360 teaching hospitals to encourage acceptance and use of their drugs/devices: $1.49B for research, $1.02B for ownership interests, $380M for speaking/consulting fees, $302M for royalties/licensing, $93M for meals, $74M for travel, and $128M for “other.”

  • Recipients of 40% of these payments were not disclosed due to data problems (data verification/accuracy) per the Center for Medicaid and Medicare Services (CMS). About 190,000 of the 4.4 million payments were for investigational drugs not approved for sale, or for drugs pending approval for new uses.
  • About 26,000 of the 546,000 physicians were able to review/correct their data before release (physicians and teaching hospitals were given 45 days to review data, correct inaccuracies before the September 30 release).
  • The biggest drug companies had the most interactions with physicians — the Top Five: Pfizer (142,600), Astra Zeneca (111,200), Forest Labs (98,900), Johnson & Johnson (97,000), and Glaxo SmithKline (85,100).

Mr. Keckley also notes that the Open Payments website is not “user friendly.” No kidding! I spent a few minutes noodling around it and got increasingly frustrated. Morning Consult’s polling data tells us that patients are eager to see how much the companies paid their doctors. 57 percent “strongly agree” or “somewhat agree” that they will look up payments made to their doctor.


Well, good luck to them. I think that few will pay attention to this after the hubbub settles down, and those that do will be sensationalist journalists and “citizen activists” looking to shake down the companies. There is no evidence whatsoever that this disclosure will improve the quality of care. It might just as likely reduce quality, as doctors fear getting “shamed” and cut back valuable relationships with manufacturers.

My response to Open Payments is fundamentally different than my response to Medicare’s disclosure of its payments to hospitals and physicians, both of which I praised sky-high. The difference is obvious: Medicare payments are taxpayers’ money, and therefore public property. Consulting fees paid to physicians by private business are not. I anticipate comments to the effect that they might drive up Medicare costs. Maybe, but then the place to identify that is in the Medicare payments.

Which brings me to my policy recommendation: Add payments from government to the Open Payments. Government itself is a network of interest groups: National Institutes of Health (NIH), Patient-Centered Outcomes Research Institute (PCORI), Center for Medicare & Medicaid Innovation (CMMI), Agency for Healthcare Research & Quality (ARHQ), etc. We’ve previously discussed conflict of interest at National Quality Forum (NQF).

All I’m asking is a level playing field.


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