Trends in Industry Payments to Physicians in the United States from 2014 to 2018

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Trends in Industry Payments to Physicians 
in the United States from 2014 to 2018
Deborah C. Marshall, MD, MAS, Elizabeth Tarras, MD;
Kenneth Rosenzweig, MD; Deborah Korenstein, MD;
Susan Chimonas, PhD

Background and Objective: Open Payments, a federal transparency program reporting industry-physician financial relationships since 2013, was established out of concern for undue industry influence on health care decision-making and costs. The effect of Open Payments is not fully understood. We sought to determine trends in physician-level payments to evaluate whether the implementation of Open Payments has been associated with a decrease in the prevalence or value of physicians interactions with industry.

Methods: We performed a retrospective, population-based cohort study of US allopathic and osteopathic physicians practicing in 2014 per the National Plan and Provider Enumeration System, excluding other clinicians (e.g., nurses, dentists) and physicians activating or deactivating their records between 2014 and 2018. Specialties were grouped by Medicare Data on Provider Practice and Specialty taxonomy classifications: primary care, medical specialty, surgical specialty, obstetrics/gynecology, hospital-based specialty, and psychiatry. National Plan and Provider Enumeration System and Open Payments identifiers were linked by text string using cross-referenced files from the beginning and end of the period.

Open Payments data on general (non-research) industry payments between January 2014 and December 2018 (excluding 2013 because of partial-year reporting) were matched to the 2014 physician cohort. Payments were aggregated per physician annually, then categorized by cumulative aggregate value ($10¯000; $10001-$25, 000; $25001-$50,000; $50,001-$100.000; $100001-$500000; and >$500,000). Values were adjusted to the 2018 Consumer Price Index.

Outcomes included proportion of physicians receiving payments, and total and median/mean annual per-physician payment values. Total-value trends were tested using linear regression. Trends in proportions of physicians receiving payments and annual per-physician payment values were tested using logistic and linear generalized estimating equations, respectively, controlling for physician-level correlation, with year as the independent variable. Analyses were stratified by specialty group and aggregate value of payment category. This study was exempted from review by the Mount Sinai institutional review board.

Results: Of the 2014 cohort of 878,308 physicians, 458,269 (52.2%) received at least one payment in 2014, declining to 394991 (45.0%) in 2018), representing a relative overall decrease of’13.8% and relative annual decrease of 3.5% (95% CI,’3.5% to 3.4%). From 2014 to 2018, these physicians received 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). The annual proportion of physicians receiving payments decreased over time across all specialties. However, total and annual payment values remained stable across specialties except for primary care, for which total value decreased.

In 2014-2018, 90.1% of physicians who accepted payments received less than $10000 Among physicians receiving lesser aggregate payments, annual values decreased over time (yearly change: for $10000, ’$11 [95% CI, $12 to ’$11]; for $10001-$25000, $100 [95% CI, ’$117 to ’$84]; and for $25001-$50000,’$135 [95% CI, ’$199 to ’$71]; P0.001). Those receiving more than $50000 accounted for 3.4% of physicians receiving payments but 82% of the total value. For these physicians, annual payment values increased or remained stable over time (yearly change: for $50001-$100000, $42 [95% CI, $96 to $179]; $100001-$500000, $866 [95% CI, $567 to $1165]; and for >$500000, ’$8487 [95% CI, $21316 to $4342].

Discussion: Since the inception of Open Payments in 2013, the proportion of physicians receiving industry payments decreased across all specialties, while the total value of payments remained stable except for a decrease in primary care. Similar to other studies, surgical and medical specialties received the highest value of payments, and value was concentrated among a minority of physicians.

Annual payment values decreased for physicians receiving lower-value total payments ($50,000), potentially due to transparency, organizational restrictions on industry interactions or decreased direct-to-physician marketing. Physicians receiving higher-value total payments (>$50000) continued to receive similar or greater amounts, perhaps reflecting evolving industry strategy that concentrates payments, for which greater return on investment is anticipated.

Study limitations include unmeasured confounding such as physician or market factors. Prevalence of payments are underestimated, because Open Payments only reports certain payment types and the analysis is limited to general payments. Prevalence and value of payments may be overestimated or underestimated because of misattribution of data to a physician or specialty. Additionally, these data are generalizable only to allopathic and osteopathic physicians.

Corresponding Author:
Deborah C. Marshall, MD, MAS, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029.

Courtesy: JAMA. 2020;324(17):1785-1788. doi:10.1001/jama.2020.11413

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