A recent research letter published in JAMA stated that since the 2014 launch of the Open Payments database, the share of physicians who received industry payments has decreased but the total value of those payments has remained the same across all specialties – except for primary care.
In preparing the research letter, the authors performed a retrospective, population-based cohort study of allopathic and osteopathic physicians in the United States that were practicing in 2014 per the National Plan and Provider Enumeration System and physicians that either activated or deactivated their records between 2014 and 2018. National Plan and Provider Enumeration System and Open Payments identifiers were linked using cross-referenced files from the beginning and end of the period.
According to the research letter, in 2014, 52.2% of doctors accepted at least one industry payment from a drug or device maker, compared to 45% in 2018. From 2014 to 2018, physicians received a total of 49.8 million payments totaling $9.3 billion. The total value was highest in medical and surgical specialties – $3.4 and $3.9 billion in aggregate, respectively.
From 2014-2018, 90.1% of physicians who accepted payments received less than $10,000 and those who received lower aggregate payments (less than $50,000), their annual values decreased over time. The note indicates that physicians receiving payments of more than $50,000 accounted for only 3.4% of physicians receiving payments but 82% of the total value. For most of those physicians, annual payment values actually increased or remained. The exception to that is physicians who received more than $500,000, whose payment values over time also decreased on average.
The note’s authors alluded to the potential reasons for the decrease in the lower-value total payments, including transparency, organizational restrictions on industry interactions, or decreased direct-to-physician marketing. The authors went on to not that the physicians who received the higher value of total payments continuing to receive similar (or greater) amounts may reflect an “evolving industry strategy that concentrates payments, for which greater return on investment is anticipated.”
It is important to note, however, a research letter is not peer reviewed, thus the statements should be taken with a grain of salt.
An editorial article in the same issue of JAMA also called for a “need to revisit current fraud and abuse laws to be able to more appropriately respond to the range of inducements, both positive and negative, that influence medical decision-making.” Carmel Shachar, JD, MPH, and Gregory Curfman, MD, believe that “current and future approaches should move away from policing all inducements to considering the specific purposes for these inducements as the triggers for regulation and oversight.” Shachar and Curfman acknowledged that using financial incentives to induce medical decisions is not inherently suspect, and that instead fraud and abuse laws should be revised to “better address payments that drive up health care spending.”