March 6th, 2019
Since mid-2014, the Physician Payments Sunshine Act has required drug and device companies to report to the government all payments and gifts to physicians, including consulting fees, speaking fees, food and drink, and research funding. All of this information is available on the Center for Medicare and Medicaid Services Open Payments website, which is searchable by physician, hospital, or company.
So far, more than 11 million records on physician payments have been published on Open Payments. But how many patients have taken advantage of this information to research their own doctors? According to a recent study in The BMJ, not many. Researchers conducted two surveys of the public, one in 2014 before Open Payments data were released and another two years after the release in 2016. To control for factors unrelated to the Sunshine Act, they separated survey respondents who lived in states where a version of the Sunshine Act had already been passed in 2014.
Only about 3% of respondents said they knew whether or not their own doctor had received industry payments.
They found that more members of the public were aware of industry payments to physicians after Open Payments data were released, but the increase was not significantly larger than in states where the legislation already existed. When asked whether they had knew if their doctor had received industry payments, fewer respondents said yes in 2016 than in 2014, despite this information being much easier to access after the Sunshine Act. Only about 3% of respondents said they knew whether or not their own doctor had received industry payments.
These results are disappointing but not altogether surprising. Simply making information available online is often not enough to encourage people to investigate the information (personally, it took writing this blog for me to search my own doctor’s payments). Despite the ease of using Open Payments, it still takes time to look up payments for one’s doctor.
Another issue is that, for most patients, finding a doctor who takes minimal industry payments is not the largest priority. We often choose doctors based on recommendations of friends, families, or other doctors; because we prefer the location of one doctor over another; or because our options for physicians are limited by our insurance network. Information on the clinical outcomes of individual physicians is difficult to find. And, as former president Barack Obama discovered when pitching the Affordable Care Act, Americans care a great deal about keeping the doctor they already have. Patients are unlikely to dump their current doctor just because they take money from industry.
But maybe we should be more open to switching doctors based on their relationship with industry. The effect of receiving industry payments on physician behavior is well-documented. For example, doctors who received more money from opioid manufacturers prescribed more opioids. And patients like Ralph Weiss, who have suffered harm from untested medical devices, would have wanted to know about their doctor receiving payments from the device company before getting their procedure.
The study authors note that disclosure alone has not proven to be an effective tool for raising awareness of conflicts of interest among patients. “Efforts beyond the unveiling of a public website will be required to improve patient use of industry payments information,” the authors write. They suggest having CMS provide leaflets and other advertisements for Open Payments, or incorporating industry payment information on their “Find a Physician” search tool.
But we can go further than that. Journalist Marshall Allen recently recounted how he became the recipient of a “Top Doctor” award, despite not being a doctor. Instead of companies trying to make money selling hundred-dollar “Best Doctor” plaques to any doctor who will bite, why not have CMS send “Top Pharma Shill” plaques to the doctors who receive the largest payments from industry and make them mount the award in their offices? I’m sure that would make patients think more closely about their doctors’ relationship with industry.