The financial relationships between doctors and the makers of drugs and medical devices have long been hidden. That’s poised to change on Tuesday with the expected release of the first government data about how much medical companies have paid doctors.
Both doctors’ groups and manufacturers spent heavily to keep the details of these transactions from public view. The Physician Payments Sunshine Act, which eventually passed into law as part of Obamacare, is mentioned in almost 2,000 lobbying reports since Republican Senator Chuck Grassley of Iowa introduced the legislation in 2007. It’s impossible to know how much companies and medical societies have spent on the issue, because lobbying disclosures lump together their spending on many issues.
The Pharmaceutical Research and Manufacturers Association, the drug industry’s prime lobby and consistently one of the biggest-spending interest groups in Washington, is among the organizations that continued to lobby on the issue after it passed into law in 2010. So, too, have physicians’ groups like the American Medical Association—an equally formidable lobbying powerhouse—and the American Society of Anesthesiologists. Big pharma companies such as Johnson & Johnson and GlaxoSmithKline have lobbied on the Sunshine Act this year, according to their disclosures. And so has 3M, the company known for office sticky notes, which controls a health-care business with revenue of $5.3 billion.
Pharma and trade groups for biotech and medical device makers urged Marilyn Tavenner, head of the Centers for Medicare and Medicaid Services, to let them review the data before they are published. “We express our longstanding support for the goals of the Physician Payments Sunshine Act,” the heads of three industry groups wrote in a Sept. 18 letter. The groups insisted that the website disclosing the data “must provide clear background information and context regarding such industry relationships.” Without that, patients might “form mistaken impressions that all payments to physicians are suspect.”
The AMA has sought more time for doctors to check the payments reports, which manufacturers file with the government and physicians can check for accuracy. The physicians’ lobby “supports the Sunshine Act,” according to an August news release, but says “it cannot support the publication of inaccurate data.”
There’s reason to be concerned that the release of the data on Sept. 30 could be rocky. The information will only cover payments made from August to December 2013. Some doctors invited to review the data reported that the system confused them with other physicians of the same name. And manufacturers may have filed wrong information. The Centers for Medicare and Medicaid Services has said that one-third of the data will be withheld without explaining why. It’s also not clear what format the information will come in or how payments will be identified.
The reports are supposed to cover a wide range of transactions. Not every dollar that changes hands between manufacturers and doctors is cause for alarm. Private industry funds legitimate research by physicians, which should be disclosed in the reports. The goal is that the documents will shed light on murkier territory, too, including travel and entertainment, speaking fees, and honoraria.
“The relationship between manufacturers and physicians is necessary,” says John Bardis, chief executive officer of MedAssets, which helps hospitals cut costs. “The true innovation in this industry comes from the science that many of these manufacturers have built.” But he says those links need to be made transparent. “The consumer and the payers and those who bear the cost of health care deserve to understand and know what those relationships are and what they cost.”
If the Sunshine Act disclosures work, patients, insurance companies, and the public will get a better sense of whether and when relationships with manufacturers influence doctors’ decisions. Do surgeons collecting speaking fees from a medical device company use that company’s implants more often than competing products? Maybe there are clinical reasons to do so. But patients will now get the chance to ask.