Open Payments: How urology measures up

September 1, 2016

Robert A. Dowling, MD, dug into the Centers for Medicare & Medicaid Services’ recently released 2015 data from the "Open Payments" initiative, and summarizes the data on payments made to urologists.

The Physician Payments Sunshine Act (“Open Payments”) has been operational now for about 3 years (www.urologytimes.com/sunshine), and most physicians are familiar with its basic requirements. Urologists, however, may not know how they measure up when it comes to payment from industry. I dug into the Centers for Medicare & Medicaid Services’ recently released 2015 data from this initiative, and will summarize the data on payments made to urologists.

Read: What urologists need to know about APMs

The Physician Payments Sunshine Act (Section 6002 of the Patient Protection and Affordable Care Act) requires that manufacturers of “covered drugs, devices, biologicals, and medical supplies” report payments or other transfers of value to physicians to the CMS. It further requires that manufacturers and group purchasing organizations (GPOs) report physician (or their family) ownership and investments interests. Finally, GPOs must report payments and transfers of value if the recipient physicians also had an ownership or investment interest during the reporting year. Physicians in training (residents) are not considered covered recipients under the law.

Next: "Payments and transfers to urologists represent a small fraction of total payments reported to CMS"

 

Payments and transfers to urologists represent a small fraction of total payments reported to CMS and, on average, a small fraction of a urologist’s professional income. In total, $31.6 million was paid to 9,285 unique urologists-about 1.6% of total provider payments ($1,999,181,104). The average payment was $153.91 and the median payment $15.89 (table 1). The maximum total of payments made to an individual urologist was $1,365,312. Only 38 urologists received over $100,000 in 2015, but in aggregate this represented more than 32% of all payments in the specialty ($10,275,912) (figure).

Compensation for services other than consulting, consulting, and royalty payments were the most common payment reasons. Most of the payments were made as cash or cash equivalents (table 2).

Next: 54% of payments linked to PCa drugs

 

54% of payments linked to PCa drugs

Twenty drugs represent one-third of manufacturer “spending” on urologists. Just over half (54%) of payments were associated with advanced prostate cancer drugs, 34% with overactive bladder drugs, and 10% with male health products. Twenty device products represent an additional 44% of manufacturer spending in the specialty: 25% of these payments were associated with prostate cancer, 21% with stones, 18% with female health, and 14% with male health. Payments from a GPO represented less than 0.3% of all payments to urologists.

Bottom line: Payments from manufacturers to urologists in 2015 reported to and by CMS under the Sunshine Act represent a small fraction of payments to all specialties. Furthermore, these payments are concentrated in a handful of individual manufacturers, drugs, devices, recipients, and disease states. Prostate cancer and OAB products 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 from the data. If you wish to conduct your own analysis, visit the CMS Open Payments page at bit.ly/OpenPaymentsinfo.

More from Dr. Dowling:

MIPS: How you will be measured going forward

MACRA pay models: What you can expect

Is a ‘perfect storm’ heading for urology?

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