CMS financial data: Who is getting paid what?

Aug 01, 2017



On June 30, 2017, the Centers for Medicare & Medicaid Services (CMS) released its 2016 Open Payments financial data (https://openpaymentsdata.cms.gov/). As a reminder, under Section 6002 of the Affordable Care Act (also known as the Physician Payments Sunshine Act) manufacturers of “covered drugs, devices, biologicals, and medical supplies” are required to report payments or other transfers of value to physicians to CMS. It further requires that drug and device manufacturers and group purchasing organizations (GPOs) report physicians’ (or their family members’) ownership and investment interests in these companies.

As part of a broader effort to increase transparency in financial ties between industry and physicians, the 2016 data release complements reporting from previous years but organizes the information slightly differently. In this article, I will review, as I did last year (see “Open Payments: How urology measures up"), some summary information and analysis about the specialty as it pertains to Open Payments data.

 

 

 

 

CMS reports that in 2016, $8.18 billion in payments or investment value was reported by 1,481 unique companies to physicians, teaching hospitals, and other entities. The total amount of payments to individual physician recipients was $2.166 billion, and the specialty receiving the most payment dollars was general orthopedic surgery (13. 9%). Payments to urology, female urology, and pediatric urology totaled $30.8 million, or approximately 1.5% of all payments (table 1).

 

 

 

 

The largest single payment to a urologist was $449,964, and that same urologist received $1.62 million in 2016 from a single manufacturer. The average payment to a urologist in 2016 was $149 and the median payment was $16.22-both relatively unchanged from 2015 reports for the specialty (table 2).

 

 

 

Forty-nine urologists received more than $100,000, representing more than 38% of all payments to urologists (figure).

 

 

 

Most of the payments to urologists came in the form of cash (table 3), and were compensation for services other than consulting, food and beverage, royalty or license, and consulting fees.

CMS requires manufacturers to associate a payment with a drug, biologic, device, or medical supply where appropriate. Payments to urologists associated with drugs and biologics totaled $12.299 million, and only 10 drugs accounted for $10.370 million (84% of drug payments and 34% of all payments). Payments associated with a medical device totaled $15.266 million or roughly half of all payments to urologists; payments associated with the top 10 devices accounted for roughly $10 million in total payments.

Products for prostate cancer and overactive bladder together represent most of the collective spending in the specialty.

Ownership interests detailed

Finally, the 2016 report also includes-by physician-the value of ownership interests in various manufacturers and GPOs by physicians. The total current value of interest held in the reporting entities in 2016 for urologists was $19.352 million. Seventy-five percent of this interest is held in three companies by four urologists, and the vast majority of urologists in the data set have no reported investments in manufacturing companies or GPOs.

Bottom line: Payments from manufacturers to urologists in 2016 reported to and by CMS under the Sunshine Act represent a small fraction of payments to all specialties. These payments are concentrated in just a handful of individual manufacturers, drugs, devices, recipients, and disease states. The vast majority of urologists appear in the data, but need not worry about the appearance of impropriety from the data.

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