A research letter recently published in JAMA, the first longitudinal study of industry payments to United States physicians, recently analyzed the Open Payments platform. According to the research team, led by a Penn State researcher, doctors received roughly $12.1 billion from pharmaceutical and device manufacturers between 2013 and 2022.
The letter used data pulled from Open Payments from 2013 to 2022, including payments (cash and non-cash equivalents) to physicians for consulting services, non-consulting services, food and beverage, travel and lodging, entertainment, education, gifts, grants, charitable contributions, and honoraria. The authors analyzed data across 39 specialties and looked at intra-specialty variation, the difference between the median amount paid to physicians in that specialty and the mean amount paid to the top 0.1% of physicians in that specialty. Authors also calculated the 25 drugs and medical devices affiliated with the largest total payments.
According to the analysis, more than half of physicians received at least one payment and about 94% of payments were associated with one or more marketed medical products. A small percentage of physicians received amounts exceeding $1 million, with orthopedic surgeons receiving the largest sum of payments, followed by neurologists and psychiatrists and then cardiologists, with pediatric surgeons receiving the smallest.
The three drugs associated with the most payments were Xarelto ($176.34 million), Eliquis ($102.62 million), and Humira ($100,17 million). The three medical devices associated with the most payments were the da Vinci Surgical System ($307.52 million), Mako SmartRobotics ($50.13 million), and CoreValve Evolut ($44.79 million).
The analysis found that while data from Open Payments may have been intended to shed light on the extent of the financial relationships between industry and physicians, the question of whether greater transparency would change any behaviors or lessen bias still remains. According to the research, mandatory reporting of the data to the Open Payments database has not changed the financial relationships between physicians and industry.
“Overall, it shows that the Open Payments is not much more than a ledger sheet,” said Andrew Foy, MD, Associate Professor of Medicine, Penn State College of Medicine, and one author of the research letter. “Whether there is a need for deterrence or changed behaviors requires a broader conversation with public involvement.” When reviewing the open payments data in the last five years Dr. Foy received funds in 2019 for two meals with total value of $231.38, at least that is what we found in the ledger sheet.