The government on Tuesday revealed in vast detail the financial ties between American medicine and the drug and medical device industries, publishing millions of records listing .5 billion in payments to doctors and hospitals over a five-month period.
About 4.4 million records were available for search and download in the new Open Payments database, reflecting payments and other financial relationships that drug and device manufacturers had with 546,000 doctors and 1,360 teaching hospitals during the last five months of 2013.
In its first hours, the website was tortuously slow. And it was incomplete: About 40 percent of the records do not identify the recipient because CMS could not match data provided by manufacturers with existing databases.
Data for a full 12-month period will be available in June, and missing recipients will be identified sometime next year, CMS said. Other data were delayed because manufacturers said they contained trade secrets.
A basic search for Sovaldi — the 0,000-per-pill hepatitis C cure that has the insurance industry up in arms — shows that Gilead Sciences made almost 2,000 identified payments related to the drug, totaling nearly 00,000. The expenditures ranged from .62 for Karam Mounzer, a Philadelphia physician, for “food and beverage,” to two payments of ,750 in speaking fees to Bruce Bacon, a St. Louis doctor, via his consulting firm.
The release could be viewed two ways: as a detailed view of the underbelly of U.S. medicine, or a flawed, sloppy release of partial information that will confuse rather than elevate understanding. The American Medical Association said Open Payments could distort the nature of relationships between industry and doctors that were vital to the advancement of medicine.
In a conference call with reporters, CMS officials made clear that agency is not “sitting in judgment,” as one put it, of potential conflicts of interest. But transparency is the goal.
“CMS is committed to transparency and this is an opportunity for the public to learn about the relationships among health care providers and pharmaceutical and device companies,” said Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services.
However the data may prove difficult for consumers to interpret without extra context. For example, the individual physician who received the highest payment on the list — Timothy Chuter — received .3 million in royalty payments from Cook Incorporated for his “contributions to the design and development” of a series of endovascular grafts.
The payments reflect the varied nature of physicians’ interactions with the drug and device industries, ranging from the vital and necessary to the somewhat embarrassing.
They included fees collected by the likes of Chuter for their part in creating drugs or devices, to charges doctors made for contributing to clinical drugs trials, to travel expenses for beachfront junkets where doctors talked up new uses for particular drugs, to investments and other ownership stakes doctors held in companies.
“There shouldn’t be too much presumption, just based on the fact of the data, about the rightness or wrongness of the interaction,” said Center for Program Integrity Shantanu Agrawal.
The public release comes after a 45-day period when the data was available privately to doctors and hospitals so they could review information and alert CMS to any problems. Only 26,000 doctors — about 5 percent of those listed — and 400 teaching hospitals registered in the system, however. The review period was frequently interrupted as CMS took down the portal to deal with technical problems.
The American Medical Association had urged the agency to delay publication until next year, and questioned the accuracy of the data. The group has also expressed concern that readers may fail to grasp that some doctor-drug company relationships are needed in order to carry out research into lifesaving drugs.
Sen. Chuck Grassley (R-Iowa), an early champion of the Sunshine Act that enabled the release, said doctors should accept public scrutiny if their payments were legitimate.
“Transparency shouldn’t stop doctors from receiving a payment if they want to,” Grassley wrote in a Des Moines Register op-ed on Tuesday. “It should empower consumers to learn whether their doctors take payments and if so, why, and whether that matters to them.”
CMS officials said the agency will introduce a more user-friendly version of the database in the coming weeks that will allow for “basic analytics” of the data. The database is also available for download.
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