Disclosure of Industry Payments to Physicians: An Epidemiologic Analysis of Early Data From the Open Payments Program

Abstract

The Centers for Medicare and Medicaid Services' Open Payments program implements Section 6002 of the Affordable Care Act requiring medical product manufacturers to report payments made to physicians or teaching hospitals as well as ownership or investment interests held by physicians in the manufacturer. To determine the characteristics and distribution of these industry payments by specialty, we analyzed physician payments made between August 1, 2013, and December 31, 2013, that were publicly disclosed by Open Payments. We compared payments between specialty types (medical, surgical, and other) and across specialties within each type using the Pearson χ(2) test and the Kruskal-Wallis test. The number of physicians receiving payments was compared with the total number of active physicians in each specialty in 2012. We also analyzed physician ownership interests. Allopathic and osteopathic physicians received 2.43 million payments totaling $475 million. General payments represented 90% of payments by total value ($430 million) (per-physician median, $100; interquartile range [IQR], $31-$273; mean ± SD, $1407±$23,766), with the remaining 10% ($45 million) as research payments (median, $2365; IQR, $592-$8550; mean ± SD, $12,880±$66,743). Physicians most likely to receive general payments were cardiovascular specialists (78%) and neurosurgeons (77%); those least likely were pathologists (9%). Reports of ownership interest in reporting entities included $310 million in dollar amount invested and $447 million in value of interest held by 2093 physicians. In conclusion, the distribution and characteristics of industry payments to physicians varied widely by specialty during the first half-year of Open Payments reporting.

Figure 1

Industry payments to allopathic and osteopathic physicians by specialty, August 1, 2013 to December 31, 2013 a. Total value of payments by form of payment* and proportion of physicians receiving payments^† b. Mean and median per-physician value^# of general industry payments Abbreviations: USD=2013 United States Dollars; ROI=Return on investment Data include payments to identified physicians in allopathic and osteopathic specialties. Form of payment is the modality used to transfer payment, including: cash or cash equivalent (‘cash’); in-kind items and services (‘in-kind’); dividend, profit or other return on investment (‘ROI’); or stock, stock option or other ownership interest (‘ownership interest’) *The proportion of payments in each form of payment category was significantly different across specialties within each type (Pearson's chi-square test, all P < .001). ^†The proportion of physicians receiving payment was significantly different across specialties within each type (Pearson's chi-squared test, all P < .001). ^#The per-physician value of general payments was significantly different across specialties within each type (Kruskal-Wallis test, all P < .001).

Figure 1

Industry payments to allopathic and osteopathic physicians by specialty, August 1, 2013 to December 31, 2013 a. Total value of payments by form of payment* and proportion of physicians receiving payments^† b. Mean and median per-physician value^# of general industry payments Abbreviations: USD=2013 United States Dollars; ROI=Return on investment Data include payments to identified physicians in allopathic and osteopathic specialties. Form of payment is the modality used to transfer payment, including: cash or cash equivalent (‘cash’); in-kind items and services (‘in-kind’); dividend, profit or other return on investment (‘ROI’); or stock, stock option or other ownership interest (‘ownership interest’) *The proportion of payments in each form of payment category was significantly different across specialties within each type (Pearson's chi-square test, all P < .001). ^†The proportion of physicians receiving payment was significantly different across specialties within each type (Pearson's chi-squared test, all P < .001). ^#The per-physician value of general payments was significantly different across specialties within each type (Kruskal-Wallis test, all P < .001).

Figure 2

Nature* of identified general payment(s) to allopathic and osteopathic physicians by specialty type as the proportion of payment reports^† (a) and of total value (b), August 1, 2013 to December 31, 2013 *Nature of payment is the reason general payment was made ^†The proportion of general payments in each nature of payment category was significantly different when compared between specialty types (Pearson's chi-squared test, all P < .001).

Figure 2

Nature* of identified general payment(s) to allopathic and osteopathic physicians by specialty type as the proportion of payment reports^† (a) and of total value (b), August 1, 2013 to December 31, 2013 *Nature of payment is the reason general payment was made ^†The proportion of general payments in each nature of payment category was significantly different when compared between specialty types (Pearson's chi-squared test, all P < .001).