Physicians payment in the United States between 2014 and 2018: An analysis of the CMS Open Payments database

Abstract

The Open Payments database reports payments made to physicians by industry. Given the potential for financial conflicts of interest relating to patient outcomes, further scrutiny of these data is valuable. Therefore, the objective of this study was to analyze physician-industry relationships by specialty type, payment type, geospatial trend, and longitudinal trend between 2014–2018. We conducted an observational, retrospective data analysis of payments from the Open Payments database for licensed United States physicians listed in the National Plan & Provider Enumeration System (NPPES). Datasets from 2013–2018 were joined using the Python programming language. Aggregation and sub-setting by characteristics of interest was done in R to calculate means and frequencies of reported general physician payments from industry across different specialties, locations, timeframes, and payment types. Normalization was applied for numbers of physicians or payments. Geospatial statistical hot spot analysis was conducted in ArcGIS. 51.73 million payment records were analyzed. In total, 50,047,930 payments were issued to 771,113 allopathic or osteopathic physicians, representing $8,702,631,264 transferred from industry to physicians over the five-year period between 2014 and 2018. The mean payment amount was $179, with a standard deviation of $12,685. Variability in physicians’ financial relationships with industry were apparent across specialties, regions, time, and payment type. A limited match rate between records in the NPPES and Open Payments databases may have resulted in selection bias of trends related to physician characteristics. Further research is necessary, particularly in the context of changing industry payment trends and public perceptions of the appropriateness of these relationships.

Trends in Industry Payments to Physicians in the First 6 Years After Graduate Medical Training

“…20 Similar trends in industry payments to neurosurgery, orthopedic surgery, and internal medicine physicians persisted in the OPP databases between 2014 and 2018. 1 The institutional review board at Johns Hopkins University exempted this study from review and waived participant consent because the data for analysis were deidentified.…”

“…Meanwhile, internal medicine was chosen as a comparison group because internal medicine accounted for the largest number and percentage of physicians of all specialties in the 2015 OPP data (103 588 of 449 864 [23%]) . Similar trends in industry payments to neurosurgery, orthopedic surgery, and internal medicine physicians persisted in the OPP databases between 2014 and 2018 . The institutional review board at Johns Hopkins University exempted this study from review and waived participant consent because the data for analysis were deidentified.…”

“…Several studies on the OPP demonstrated significant financial relationships and potential conflicts of interest between industry and active physicians in the US. 1,5,6,17,[29][30][31][32][33][34][35][36][37] For example, in 2015, approximately 48% of all active US physicians accepted a total of $2.4 billion in industry-related payments ($1.8 billion in general payments, $75 million for research payments, and $544 million for ownership or investment interests), with a higher likelihood and higher value of payments to physicians in surgical specialties than to those in primary care specialties and to male than to female physicians. 20 However, most studies on the OPP so far have examined the prevalence of financial relationships between industry and all active physicians, both established and newly independent physicians.…”

“…Financial incentives and conflicts of interest have been considered important elements that may influence physician decision-making and may contribute to an increase in health care costs. [1][2][3] Although physicians and researchers collaborate with the pharmaceutical and medical device industry to develop products to benefit patients, increasing concerns have been raised that these relationships may affect the cost of drugs and medical devices, the quality of patient care, the integrity of scientific investigations, medical education, and clinical practice recommendations. [4][5][6][7][8][9][10][11] Substantial efforts have been made to identify, limit, and manage potential conflicts of interest in financial relationships between physicians and industry to protect the integrity of professional judgment and to preserve public trust.…”

“…12 The OPP houses a publicly accessible database of payments to physicians and teaching hospitals that reporting entities, such as pharmaceutical and medical device manufacturers, submit annually to the Centers for Medicare & Medicaid Services (CMS). 12 The payments in the OPP are reported across 3 major categories: (1) general payments: payments or other transfers of value made that are not in connection with a research agreement or research protocol (eg, travel or lodging, consulting or speaking fees, or entertainment); (2) research payments: payments or other transfers of value made in connection with a formal research agreement or research protocol; and (3) physician ownership or investment interest: information about the ownership or investment interests that physicians or their immediate family members have in the reporting entities. 13 The annual total dollar value of payments in the OPP, including general payments, research payments, and ownership or investment interest, increased steadily from $8.61 billion in 2014 to $10.03 billion in 2019.…”