The initial release included 4.4 million payments totaling $3.5 billion to 546,000 physicians and 1,360 teaching hospitals. Subsequent full-year releases will not only improve on the quantity and quality of the data and its usability, but it will build the long-term record that is always most valuable to users. Data points are interesting. Trends are instructive.
Most physicians insist that their financial dealings with drug or device companies do not influence their prescribing behavior. Yet a large body of research has shown that taking a free lunch or speaking on behalf of the company can and does influence healthcare decisions.
Moreover, claiming otherwise ignores the well-established norm in the social sciences that gift-giving and monetary exchange creates a sense of mutual obligation between the parties.
The antidote to that norm for a country now demanding higher quality and lower costs from its healthcare providers is transparency and shame. The goal of the Sunshine Act's architects—Sen. Chuck Grassley (R-Iowa) was the chief proponent—is to expose payments, and thereby reduce them.
There is anecdotal evidence to suggest that the law was having its intended effect ahead of the database's initial release. Affected industries have cut back on their payments in recent years. The small armies of drug reps that handed out free pizzas, mugs and notepads at physician offices and conferences have been pared back.
Many doctors stopped attending thinly disguised “educational” seminars at fancy golf resorts and cut back on accepting free meals. Why risk having your name exposed in a public database as “on the take” for a $20 lunch?
But the database also revealed that industry's involvement with the core missions of a range of healthcare providers is far from over. It is in these hidden corners of healthcare—not the relationship between an individual physician and his patient—where the annual Open Payments releases will do the most good.
It's instructive that drug and device companies spent twice as much on speaking and consulting fees for physician “thought leaders” as they did on food, travel and lodging, which are more typically given to the individual physicians who are on the receiving end of the lectures. Payments for royalties and licenses dwarfed the other categories.
How will exposing the specifics in these instances help?
Say you are a hospital official trying to standardize use of a particular orthopedic implant based on medical evidence of its superior efficacy, reduced complications and lower cost. If it becomes widely known that surgeons who are resisting the move have financial ties to a different manufacturer, the discussion inside the department may take on an entirely different tone.
That's the promise of physician payment data transparency. Providers with conflicts of interest who make decisions that aren't firmly rooted in what's best medically and financially for their patients will be exposed.
Follow Merrill Goozner on Twitter: @MHgoozner
