The Affordable Care Act, which was passed in 2010, required the Centers for Medicare & Medicaid Services (“CMS”) to establish a publicly-accessible database with the goal of increasing transparency about financial relationships between the drug and medical device industry and healthcare providers. Such data could then be used to provide insight into potential conflicts of interest. The result is the CMS Open Payments website. Open Payments collects and publishes data relating to payments to healthcare providers for various activities, including “research, meals, travel, gifts, or speaking fees.” Open Payments contains data from August 2013 to December 2017.
While the Open Payments program was intended to increase transparency, some were concerned that there would be unintended consequences of disclosing such information. A recent study out of the University of Pennsylvania suggests that one such unintended consequence has indeed come to pass. Genevieve Kanter, PhD, and her colleagues published an article on April 12, 2019 in JAMA Open Network, directed to the effect of the Open Payments program on patient trust of their doctors. In the study, the authors conducted a longitudinal study wherein 1,388 US adults were surveyed prior to the launch of the Open Payments website, and again two-years after the website launch. The authors found a 2.7% decrease in each participant’s trust in their own physician, even when the participant knew that their doctor had not received any industry payments. The authors concluded that “public disclosure may have resulted in negative reputational spillovers affecting ‘pharma-free’ physicians with industry ties.”
The BMJ has also gotten in on the transparency trend. On April 16, 2019, the BMJ announced a new stream of content to revisit the countervailing goals of collaboration with industry to develop new products that improve health, and financial conflicts of interest that “jeopardize the integrity of science, the objectivity of education, the quality of care, and public trust in medicine.” The goal of this effort is to identify and respond to commercial influences on healthcare, and to determine when industry involvement is truly necessary. When such involvement is not necessary, the BMJ wants to forge independence from industry in order to strengthen trust in the healthcare system.
Studies have shown that trust is a crucial component of the doctor-patient relationship. Specifically, patient trust in their doctor predicts certain healthy behaviors, such as the use of preventative services, intended or reported adherence to treatment recommendations, and continuity with providers. Thus, the various initiatives to increase transparency may actually produce the opposite of their desired effect, if that increase in transparency leads to a decrease in doctor-patient trust, and a corresponding decrease in patients’ health.