Many individuals personally involved in the healthcare industry are familiar with the “Open Payments” database published each year by the Center for Medicare and Medicaid Services (CMS). This database, sometimes referred to as the Physician “Sunshine” database was created as a part of the Affordable Care Act in 2010, and requires that pharmaceutical companies and medical device manufacturers report payments made to physicians and teaching hospitals for services such as promotional talks, consulting, research and royalty agreements.
On June 30th this year, CMS released payment data covering the period from January 1, to December 31, 2015. Companies reported more than $7.5 billion in payments from 1,456 companies to 618,000 physicians and 1,110 Teaching Hospitals. Within two weeks, local newspapers around the country were reporting on payments to their local physicians with headlines like these:
“St. Louis area physicians dominate list of Missouri docs receiving industry money” (St. Louis Post Dispatch)
“Iowa doctors get more than $12.6 million in outside payments” (The Gazette)
“Analysis: More than 80 percent of doctors at three Arizona hospitals accept drug-company payments” (The Republic)
“South leads the nation in drug and device company payments to doctors” (USA Today)
The database is doing its job: It is bringing attention to payments made to physicians, giving patients the ability to take those payments into account when selecting a physician or a course of treatment, and possibly influencing whether a physician agrees to accept payments and valuable perks in the future.
However, lately I have seen some different types of headlines and stories:
“Hospital CEO in the hot seat over hefty outside board compensation
UCSF Medical Center CEO is under scrutiny for receiving $5 million in stock and cash in recent years for being a board member of companies that do business with the hospital. (San Francisco Business Times)
“Conflict of interest: Academic leaders on US healthcare industry boards
Researchers looked at 279 academically affiliated directors on the boards of 442 companies in 2013. These leaders included 17 CEOs and 11 vice presidents or executive officers of health systems and hospitals, as well as 15 university presidents and eight medical school deans or presidents. On average, these leaders earned $193,000 a year and got at least 50,000 shares of stock in exchange for serving on the boards.
In total, they earned $55 million in compensation and owned roughly $60 million in stock options.” (FierceHealthcare)
These articles reveal, on the basis of disclosures made by the executives themselves, payments from industry in the hundreds of thousands, and even millions of dollars for Board participation, consulting, and other services. These payments are made by the same companies that are required to report payments to physicians with the goal of eliminating, or at least mitigating, potential conflicts of interest. Yet there is no corresponding requirement that companies report payments to healthcare executives, who may, all things considered, have as great or greater influence on how healthcare dollars are spent.
It is highly unlikely that a mandate requiring that payments to healthcare executives be reported publicly would be proposed or acted on in an election year, but perhaps we should put the topic on the table for consideration at some point after the dust settles in November.
Bill Sacks, Vice President COI Product Management