About 41% of physicians in the U.S. receive payments from medical device manufacturers and drug companies. But the proportion of patients seen by physicians who accept payments is a noticeably higher 65%, according to a new study published in the Journal of General Internal Medicine.
Meanwhile, 5% of patients knew whether or not their doctors had received payments, according to the study. These findings raise broader questions about conflicts of interest in medicine and the impact of industry payments to physicians on healthcare costs and patient outcomes.
Genevieve Pham-Kanter, the lead author and an associate professor at Drexel University in Philadelphia, collaborated with Stanford and Harvard researchers on the study. She said they wanted to answer the question, "What is the extent of the influence at the patient care level?”
What they found suggested that although a minority of physicians receive payments from the industry, a majority of patients are seeing those physicians.
“The reach of industry influence in clinical care could be much greater than the prevalence of payments among physicians would suggest,” the researchers wrote in their study.
The study and its implications raise important questions about outcomes and costs and leave many areas open for further research. If physicians with closer industry ties are motivated to prescribe more expensive branded drugs, for example, they could drive up healthcare spending. Another question is whether physicians under the influence of industry payments might act against a patient's best interests.
The researchers surveyed a nationally representative sample of 3,542 adults in late September and early October 2014, getting the names of a healthcare provider from 84% of them. Using data from the government website Open Payments, which was created under the Affordable Care Act, they were able to link 1,987 of those respondents to a specific physician to find that overall, 65% of them had seen physicians who received payments from the industry in the previous 12 months.
The proportion varied by medical specialty. Forty-two percent of family practice physicians have received industry payments, for instance, but 63% of patients saw family doctors who had received payments. Meanwhile, 47% of OB-GYNs received industry dollars, but 77% of patients saw OB-BYNs who took those payments.
Why might patients disproportionately see physicians who receive industry payments? The study didn't answer that question specifically, although Pham-Kanter had one idea.
“It's most likely that the drug and device companies are targeting their marketing to doctors who see a lot of patients,” Pham-Kanter.
Previous research has uncovered evidence of some physicians, paid by the industry, acting against a patient's best interest. In 2015, a Modern Healthcare analysis of Open Payments and Medicare drug data found that 23% of the highest-prescribing physicians in Medicare accepted non-research payments from the corresponding drugmaker.
“If the doctors who have industry contact are more expensive for the system, I think that would be a good motivation for (the health system and payers) to act,” said Pham-Kanter. It's in the interest of insurers and health systems to have doctors make high-value clinical decisions, she pointed out. “To the extent that payments might distort that, I would encourage them to look into the full costs of the decisions that their providers are making.”
One concern is that future research into potential medical conflicts of interest and the subtle—or overt—sway of industry dollars over physicians' decisions may be stymied if the Affordable Care Act is repealed, as President Donald Trump and Republicans have promised to do. The Open Payments program was created under that law, and in August 2013, it began requiring drug and device manufacturers to report to CMS their payments and gifts to physicians.