"There is nothing in the data to suggest any widespread abuse, improper inducements, or impropriety in the specialty. Nevertheless, urologists should be aware that this is an area of continued scrutiny by Congress and watchdogs," writes Robert A. Dowling, MD.
On June 30, 2023, the Centers for Medicare & Medicaid Services (CMS) published its latest Open Payments data and summary report (for 2022). In my most recent article, I reviewed general payments to urologists—payments such as speaking fees, consulting fees, food and beverage in-kind contributions, and royalties.1 The Physician Payments Sunshine Act applies to other transfers of value—including investments and ownership by physicians and their immediate family. This is an area that has received less attention than general payments. In this article, I will review the Open Payments ownership data with a focus on how urologists compare to other specialties.
The Sunshine Act requires that manufacturers and group purchasing organizations (GPOs) report transfers of value made during the reporting year—investments such as stock or stock options—as well as the cumulative value of interest held by physicians or their immediate family. For context, in 2022, $2.5 billion in general payments to physicians were reported; in the same year, $304 million of new physician investment was reported. The cumulative value of physician (or their family) ownership in 205 companies reported in 2022 was $1.29 billion; this was distributed among only 3574 physicians and new investments were reported for only 1112 covered recipients.2 In other words, very few physicians have ownership interests reported in the Open Payments data.
Which specialties are receiving transfers of value from manufacturers and GPOs? Table 12 shows the specialties ranked by cumulative value of interest held by physicians. Internal medicine tops the list with 23% of all cumulative interest, followed by family medicine (21%) and orthopedics (8%). Urology ranks eighth among all specialties with a total cumulative value of interest of $24 million (1.9%) and investments made in 2022 of just over $1 million.
Which companies reported ownership interests by urologists? Table 22 details ownership and investment information for 302 urologists as of 2022. Over half the value reported was from a single entity (GPO) reporting on 241 urologists. The remaining ownership interests involved a small number of urologists and manufacturers of device products or services. In short, very few urologists appear to be covered recipients of ownership interest in manufacturers or GPOs.
Transfers of ownership value—dividends, cash, stock, stock options, and other interest—can also be reported as “general payments” by manufacturers or GPOs (see below). In 2022, approximately $15.5 million was reported across all specialties, and $329,000 to a handful of urologists.
The Sunshine Act is currently updated with other Medicare payment policies by rulemaking. In the 2022 Physician Fee Schedule final rule, the CMS updated 2 items relevant to this discussion.3 First, it removed the category of ownership interest under General Payments (see above) to promote consistency in reporting ownership information: Going forward, all such transfers of value will be reported as “ownership data” apart from other payments. Second, it clarified that physician-owned distributorships (PODs) are required to report under Open Payments and must self-identify as such. PODs are physician-owned entities that derive revenue from the distribution or sale of medical devices—to date, mostly in the orthopedic surgery space (implants). PODs are controversial, are proliferating, and have garnered the attention of congressional oversight committees because of a number of ethical and legal concerns.4,5 The 2022 Open Payments data do not allow the identification of PODs per se, but this new regulation may allow more transparency in the future. The POD model is potentially applicable in urology (implants).
The Sunshine Act brings some transparency to physician ownership interest in companies that sell or distribute products and services relevant to their practice. The Open Payments data suggests that only a small fraction (3%) of urologists have such an interest. There is nothing in the data to suggest any widespread abuse, improper inducements, or impropriety in the specialty. Nevertheless, urologists should be aware that this is an area of continued scrutiny by Congress and watchdogs.
1. Dowling RA. Open Payments 2022: an analysis of industry payments to urologists. Urology Times®. August 7, 2023. Accessed August 7, 2023. bit.ly/3qjfkhl
2. The facts about Open Payments data. Centers for Medicare & Medicaid Services. Accessed July 5, 2023. https://openpaymentsdata.cms.gov/summary
3. Centers for Medicare & Medicaid Services. Medicare program; CY 2022 payment policies under the physician fee schedule and other changes to Part B payment policies; Medicare shared savings program requirements; provider enrollment regulation updates; and provider and supplier prepayment and post-payment medical review requirements. Fed Regist. 2021;86(221):64996-66031
4. Senate Finance Committee. Physician owned distributors (PODs): an overview of key issues and potential areas for congressional oversight. June 2011. https://www.finance.senate.gov/imo/media/doc/POD%20Analysis%20June%202011.pdf
5. Senate Finance Committee. Physician owned distributorships: an update on key issues and areas of congressional concern. https://www.finance.senate.gov/imo/media/doc/Combined%20PODs%20report%202.24.16.pdf