Last week, MedPAC (the Medicare Payments Advisory Commission), an important advisory committee to congress, held their September public meeting. Topics of discussion included the Open Payments database and consideration of ways to add further transparency to the payments from pharmaceutical and device manufacturers to physicians and teaching hospitals. MedPAC Commissioners mulled numerous modifications to Open Payments, including requiring reporting of payments to currently excluded healthcare professionals like nurses and physician assistants and indicating the type of entity making payments (i.e., drug or device manufacturer or GPO). Other suggestions included pairing the payments database with physician prescribing data in future analyses.
MedPAC is a 17-person independent agency established to advise the Congress on issues affecting the Medicare program. Notably, back in 2008 and 2009, the Commission was active in the formation of what became eventually the Physician Payments Sunshine Act provisions of the Affordable Care Act. Read our writeup from 2009, and a transcript from MedPAC’s 2008 session outlining their Open Payments proposal.
Now, MedPAC is back at it and recently issued a presentation on the 2014 Open Payments data and recommendations (see the slide deck and meeting brief prepared by two MedPAC staff members). In it, Ariel Winter and Anna Harty walk through the Open Payments requirements, provide an analysis of the 2014 Open Payments database, and offer a glimpse into potential next steps (see Slide 12).
The slides offer some interesting insights into the current data. “The distribution of general payments among physicians is highly concentrated at the top,” noted the presenters. The top 5 percent of physicians who received payments account for 86 percent of the total payments,” and the “top 10 percent…account for 91 percent of total dollars.” 70% of MD’s and DO’s who billed medicare received payments from manufacturers. MedPac staff also discussed that the research database was difficult to analyze: “we didn’t calculate the average research payment per physician because research institutions may list multiple physicians as principal investigators.”
They also noted that Orthopedic Surgeons received 23% and Cardiologists received 7% of the total value of payments in the general database. They failed to mention that most of this is a result of huge royalty payments made to those Orthopedic Surgeons.
The MedPac staff identified a number of changes that would “improve the usefulness of the data.” For example:
[I]ndicating in the database whether it was a GPO or a manufacturer that made the payments, as well as the type of manufacturer that made payment, for example, a device or a drug manufacturer.
[R]equiring manufacturers to report payments to other health professionals and organizations.
[Examining] the relationship between physicians ‘prescribing behavior and the payments they receive from manufacturers. We could also explore trends as more years of data are released.
Along with the presentation, other members of MedPAC offered their take on what they would view as improvements to the physician payment transparency. A number of notable proposals included:
- One member recommended that it would be useful to see Open Payments data expressed “as a share of income.” Other members agreed, though noted that average income per specialty may be more feasible. “If somebody is getting an increment of 1 or 2 percent, you interpret that one way,” he noted. “If somebody is getting 30, 40 percent of what’s their normal income in additional gifts, that’s going to tell us a different story, so it’s just a way to help to enlighten what the numbers are meaning to us.”
- Another suggested that more transparency should extend to payments to sales reps, “especially around device organizations.”
- Another recommendation was to make sure that patients are aware of Open Payments. “Doctors need to disclose if they have a relationship with a drug or device that they are prescribing,” she recommended,” the member said.
- Members also discussed the potential for increased transparency around research payments and samples.
A number of MedPAC members had some questions about how meaningful certain transparency measures would be. For example, a number of members highlighted the enormous resources invested in finding out who drinks a cup of coffee. Members coming from the device side also reiterated the importance of reps during surgery procedures. One member noted: “once you get into the operating room, the rep is there to ensure a level of safety with using the devices,” and “the reps are essential for the whole process.”
It will be important to keep an eye of MedPAC’s activity in the Open Payments arena, and how the Committee’s discussion evolves from the recommendations they discussed last week in future meetings. There is opportunity for public comment on their proposal to expand Open Payments: click here to submit a comment.
Most recently,MedPAC indicated their support to CMS in changing the fee schedule for adding Open Payments data to CMS’s Physician Compare website (see page 9). The committee stated that: “We also support CMS linking to the Open Payments data from the individual Physicians Compare web pages and also providing a link to the spending and volume data.”
Resources
Transcript of the MedPac Open Payments Discussion 9-11
Slides of MedPac Open Payments Presentation
MedPac Commission Members