Dr. Dowling is president of Dowling Medical Director Services, a private health care consulting firm specializing in quality improvement, clinical informatics, and health care policy affecting specialty care. He is the former medical director of a large,
Prostate cancer, BPH, and overactive bladder represent the most spending in the specialty.
On June 29, 2018, the Centers for Medicare & Medicaid Services (CMS) released its 2017 Open Payments Financial Data (https://openpaymentsdata.cms.gov/).Section 6002 of the Affordable Care Act (also known as the Physician Payments Sunshine Act) requires that manufacturers of “covered drugs, devices, biologicals, and medical supplies” report payments or other transfers of value to physicians to CMS. It also requires that manufacturers and group purchasing organizations (GPOs) report to CMS ownership or investment interests that physicians (or their family members) have in their company.
Payments see increase from 2016
In 2017, $8.4 billion in payments or investment value was reported by 1,525 unique companies to physicians, teaching hospitals, and other entities; this is an increase of 2.4% over the 2016 total. The total amount of general payments to individual physician recipients was $2.82 billion, research payments totaled $4.66 billion, and other transfers of value (investments, etc.) were just over $927 million.
According to the data, 9,343 urologists received a total of $35,961,655 in general payments, or 1.27% of the total general payments. The largest single payment to a urologist was $3 million for royalty/license, and the average payment to a urologist in 2017 was $176.42. Fifty-four urologists received more than $100,000, representing more than 47% of all payments to urologists (table "Summary of payments to urologists, 2015-'17" and figure). Most of the payments to urologists came in the form of cash, and were compensation for royalty or license, services other than consulting, consulting fees, and food and beverage (tables 2 and 3).
CMS requires manufacturers to associate a payment with a drug, biologic, device, or medical supply where appropriate. General payments to urologists associated with devices comprised the largest collective payments, totaling $19,867,410, or more than half of all general payments; the majority of these payments were from six device manufacturers. Payments associated with drugs and biologics totaled almost $12 million, less than in 2016; eight drug manufacturers accounted for almost 80% of total payments in this category.
CMS reported $1,099,241 in research payments from 17 manufacturers to 64 unique urologists in 2017; this represents a tiny fraction of 2017 total research payments to physicians overall. CMS also reports on transfers of value outside of general payments and research payments. In 2017, $3.8 million in investments were transferred to urologists from nine entities, most in the form of common stock.
Bottom line: General payments from manufacturers to urologists in 2017 reported to and by CMS under the Sunshine Act represent a tiny fraction of general payments to physicians; conversely, research payments to urologists were a tiny fraction of payments to physicians. Most of these payments are from device manufacturers, and payments are concentrated in just a handful of individual companies, drugs, devices, recipients, and disease states. Prostate cancer, BPH, and overactive bladder together represent most of the collective spending in the specialty.
The vast majority of urologists appear in the data, but need not worry about the appearance of impropriety.