The ‘Open Payment’ programme created by the Affordable Care Act in the US, has led the way in the commitment to transparency when it comes to revealing payments from pharmaceutical companies to the healthcare industry. The Centres for Medicare and Medicaid Services (CMS) now host on their website an easy-to-use database, which includes the consulting fees, research grants, travel reimbursements and other gifts, medical device manufacturers and pharmaceutical companies have provided to doctors and teaching hospitals during the last five months of 2013.
The data are vast: containing 4.4 million payments, valued at nearly $3.5 billion, attributable to 546,000 individual physicians and almost 1,360 teaching hospitals. Yet more than $1.1 billion in transactions have not yet been included, mostly due to disputes over data reported by drug and device makers. The CMS plans to make sure the site will be updated next year, however, and future reports – published annually – will include a full 12 months of payment data, beginning in June 2015.
Dealing with such a large dataset requires a powerful, yet easy-to-use online search tool if it is to be useful to the public. The CMS have claimed that they are continually improving the system to allow for easier data searches. Currently, the system lets you search by the name of a doctor, the location or the speciality as well as by the names of teaching hospital and companies. After a search for a specific doctor, for example, a clear summary page is revealed that groups all transfers of value by general payments, research payments, and ownership in companies. The summary page shows the nature of the payments (such as food and beverage, education and consulting), the date of payments and the individual amounts. It is also lists if any data was disputed by an individual doctor.
Over time, CMS expects to make enhancements, such as introducing new search functions to allow users to more easily review payments received by their personal doctor, or search on criteria such as specialty, location, or types of payments received. The Wall Street Journal has created a “Medical Money” interactive tool, based on the payment data that allows you to see aggregate payment amounts by company: http://graphics.wsj.com/medical-money/.
There many who has championed the increased transparency that the payment data brings, however most of the debate surrounding the publication of payment data centres on the consequences of public reporting. According to critics, it is not yet clear how these data will be used once published; how they will be interpreted; or what impact they will have on the behaviour of individuals, the practice of research, or how policy makers’ decide to regulate healthcare-pharmaceutical industry relationships.
Both healthcare and pharmaceutical manufacturer representatives have raised concerns over how patients will interpret the payment data information. It is important, they claim, that payments are published in context – with information that allows the viewer to see exactly what the payment is linked to and what it represents. There is still room for improvement therefore when it comes to presenting the data to the public to make it clear the difference between payments that inappropriately influence prescribing and payments that are made for services that are helpful for the innovation of new drugs or therapies and to improve clinical practice.
Ruth Knowles is a freelance science writer who has written articles and press releases on a range of life science and health topics. She received her MSc in Science Communication from the University of the West of England, Bristol.