Physician characteristics, industry transfers, and pharmaceutical prescribing: Empirical evidence from medicare and the physician payment sunshine act.
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ABSTRACT: Objective
To evaluate physician characteristics associated with pharmaceutical industry transfers and prescribing behavior after public reporting under the Sunshine Act.Data sources
2014-2016 secondary data on industry transfers to physicians from the Open Payments Dataset supplemented with Medicare Part D prescription data, Medicare service data, and practice attributes from the Physician Compare Database.Study design
Using regression analysis with county/physician fixed effects, this study examines characteristics associated with the probability/magnitude of transfers and the association between transfers and prescriptions.Data collection
Using an iterative matching approach, this study identifies physicians who delivered outpatient Medicare services in 2014 (n = 409 041) and tracks their annual transfers between 2014 and 2016 (N = 1 227 123) across six transfer categories. In addition, it examines their Medicare Part D prescription behavior between 2014 and 2015 (N = 741 659).Principal findings
Industry transfers dramatically declined in 2015 and 2016. Transfers are significantly associated with increased prescription costs, branded prescribing, and prescribing for High-Risk Medications (HRMs).Conclusions
Industry transfers have declined after public reporting. Transfers are associated with higher prescription costs and incidence of HRMs. Future research is needed to determine the causal impact on quality and cost-effectiveness of prescribed medications.
SUBMITTER: Brunt CS
PROVIDER: S-EPMC6505404 | biostudies-literature | 2019 Jun
REPOSITORIES: biostudies-literature
Publications
Physician characteristics, industry transfers, and pharmaceutical prescribing: Empirical evidence from medicare and the physician payment sunshine act.
Health services research 20181001 3
<h4>Objective</h4>To evaluate physician characteristics associated with pharmaceutical industry transfers and prescribing behavior after public reporting under the Sunshine Act.<h4>Data sources</h4>2014-2016 secondary data on industry transfers to physicians from the Open Payments Dataset supplemented with Medicare Part D prescription data, Medicare service data, and practice attributes from the Physician Compare Database.<h4>Study design</h4>Using regression analysis with county/physician fixed ...[more]
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Project description:BACKGROUND:The U.S. Physician Payments Sunshine Act mandates the reporting of payments or items of value received by physicians from drug, medical device, and biological agent manufacturers. The impact of these payments on physician prescribing has not been examined at large scale. METHODS:We linked public Medicare Part D prescribing data and Sunshine Act data for 2013. Physician payments were examined descriptively within specialties, and then for association with prescribing costs and patterns using regression models. Models were adjusted for potential physician-level confounding features, including sex, geographic region, and practice size. RESULTS:Among 725,169 individuals with Medicare prescribing data, 341,644 had documented payments in the OPP data (47.1%). Among all physicians receiving funds, mean payment was $1750 (SD $28336); median was $138 (IQR $48-$394). Across the 12 specialties examined, a dose-response relationship was observed in which greater payments were associated with greater prescribing costs per patient. In adjusted regression models, being in the top quintile of payment receipt was associated with incremental prescribing cost per patient ranging from $27 (general surgery) to $2931 (neurology). Similar associations were observed with proportion of branded prescriptions written. CONCLUSIONS:While distribution and amount of payments differed widely across medical specialties, for each of the 12 specialties examined the receipt of payments was associated with greater prescribing costs per patient, and greater proportion of branded medication prescribing. We cannot infer a causal relationship, but interventions aimed at those physicians receiving the most payments may present an opportunity to address prescribing costs in the US.
| S-EPMC4868346 | biostudies-literature
Project description:BackgroundThe association between pharmaceutical industry promotion and physician opioid prescribing is poorly understood. Whether the influence of industry gifts on prescribing varies by specialty is unknown.ObjectiveTo examine the relationship between opioid-related gifts to physicians and opioid prescribing in the subsequent year across 7 physician specialties.DesignPanel study using data from 2014 to 2016.Participants236,103 unique Medicare Part D physicians (389,622 physician-years) who received any gifts from pharmaceutical companies measured using Open Payments and prescribed opioids in the subsequent year.Main measuresAmounts paid by pharmaceutical companies for opioid-related gifts including meals and lodging; quartile of opioid prescribing as a percent of total prescribing compared with other same-specialty physicians.Key resultsIn 2014-2015, 14.1% of physician received opioid-related gifts from the industry with 2.6% receiving > $100. Gifts varied by specialty and were concentrated among two pharmaceutical companies responsible for 60% of the value of opioid-related gifts. Receiving opioid-related gifts was associated with greater prescribing of opioids compared with same-specialty physicians in the next year. Primary care physicians are nearly 3.5 times as likely to be in the highest quartile of prescribing versus the lower quartiles if they were paid ≥ $100. Psychiatrists and neurologists were 7 to 13 times as likely to be in a higher quartile of opioid prescribing compared with colleagues who were paid $0 in the preceding year.ConclusionsThe value of opioid-related gifts given to physicians varies substantially by provider specialty, as does the relationship between payment amounts and prescriber behavior in the following year.
| S-EPMC7403285 | biostudies-literature
Project description:BackgroundFinancial payments from the drug industry to U.S. physicians are common. Payments may influence physicians' clinical decision making and drug prescribing.PurposeTo evaluate whether receipt of payments from the drug industry is associated with physician prescribing practices.Data sourcesMEDLINE (Ovid), Embase, the Cochrane Library, Web of Science, and EconLit were searched without language restrictions. The search had no limiting start date and concluded on 16 September 2020.Study selectionStudies that estimated the association between receipt of industry payments (exposure) and prescribing (outcome).Data extractionPairs of reviewers extracted the primary analysis or analyses from each study and evaluated risk of bias (ROB).Data synthesisThirty-six studies comprising 101 analyses were included. Most studies (n = 30) identified a positive association between payments and prescribing in all analyses; the remainder (n = 6) had a mix of positive and null findings. No study had only null findings. Of 101 individual analyses, 89 identified a positive association. Payments were associated with increased prescribing of the paying company's drug, increased prescribing costs, and increased prescribing of branded drugs. Nine studies assessed and found evidence of a temporal association; 25 assessed and found evidence of a dose-response relationship.LimitationThe design was observational, 21 of 36 studies had serious ROB, and publication bias was possible.ConclusionThe association between industry payments and physician prescribing was consistent across all studies that have evaluated this association. Findings regarding a temporal association and dose-response suggest a causal relationship.Primary funding sourceNational Cancer Institute.
| S-EPMC8315858 | biostudies-literature
Project description:ImportanceIn an effort to regulate physician conflicts of interest, some US academic medical centers (AMCs) enacted policies restricting pharmaceutical representative sales visits to physicians (known as detailing) between 2006 and 2012. Little is known about the effect of these policies on physician prescribing.ObjectiveTo analyze the association between detailing policies enacted at AMCs and physician prescribing of actively detailed and not detailed drugs.Design, setting, and participantsThe study used a difference-in-differences multivariable regression analysis to compare changes in prescribing by physicians before and after implementation of detailing policies at AMCs in 5 states (California, Illinois, Massachusetts, Pennsylvania, and New York) that made up the intervention group with changes in prescribing by a matched control group of similar physicians not subject to a detailing policy.ExposuresAcademic medical center implementation of policies regulating pharmaceutical salesperson visits to attending physicians.Main outcomes and measuresThe monthly within-drug class market share of prescriptions written by an individual physician for detailed and nondetailed drugs in 8 drug classes (lipid-lowering drugs, gastroesophageal reflux disease drugs, diabetes drugs, antihypertensive drugs, hypnotic drugs approved for the treatment of insomnia [sleep aids], attention-deficit/hyperactivity disorder drugs, antidepressant drugs, and antipsychotic drugs) comparing the 10- to 36-month period before implementation of the detailing policies with the 12- to 36-month period after implementation, depending on data availability.ResultsThe analysis included 16 121 483 prescriptions written between January 2006 and June 2012 by 2126 attending physicians at the 19 intervention group AMCs and by 24 593 matched control group physicians. The sample mean market share at the physician-drug-month level for detailed and nondetailed drugs prior to enactment of policies was 19.3% and 14.2%, respectively. Exposure to an AMC detailing policy was associated with a decrease in the market share of detailed drugs of 1.67 percentage points (95% CI, -2.18 to -1.18 percentage points; P < .001) and an increase in the market share of nondetailed drugs of 0.84 percentage points (95% CI, 0.54 to 1.14 percentage points; P < .001). Associations were statistically significant for 6 of 8 study drug classes for detailed drugs (lipid-lowering drugs, gastroesophageal reflux disease drugs, antihypertensive drugs, sleep aids, attention-deficit/hyperactivity disorder drugs, and antidepressant drugs) and for 9 of the 19 AMCs that implemented policies. Eleven of the 19 AMCs regulated salesperson gifts to physicians, restricted salesperson access to facilities, and incorporated explicit enforcement mechanisms. For 8 of these 11 AMCs, there was a significant change in prescribing. In contrast, there was a significant change at only 1 of 8 AMCs that did not enact policies in all 3 areas.Conclusions and relevanceImplementation of policies at AMCs that restricted pharmaceutical detailing between 2006 and 2012 was associated with modest but significant reductions in prescribing of detailed drugs across 6 of 8 major drug classes; however, changes were not seen in all of the AMCs that enacted policies.
| S-EPMC5815013 | biostudies-literature
Project description:BackgroundIncreasingly, medical school policies limit pharmaceutical representatives' access to students and gifts from drugmakers, but little is known about how these policies affect student attitudes toward industry.ObjectiveTo assess interactions between trainees and the pharmaceutical industry, and to determine whether learning environment characteristics influence students' practices and attitudes.Design, participantsWe conducted a cross-sectional survey with a nationally-representative sample of first- and fourth-year medical students and third-year residents, stratified by medical school, including ? 14 randomly selected trainees at each level per school.Main measuresWe measured frequency of industry interactions and attitudes regarding how such interactions affect medical training and the profession. Chi-squared tests assessed bivariate linear trend, and hierarchical logistic regression models were fitted to assess associations between trainees' attitudes and their schools' National Institutes of Health (NIH) funding levels and American Medical Student Association (AMSA) PharmFree Scorecard grades reflecting industry-related conflict of interest policies.Key resultsAmong 1,610 student (49.3 % response rate) and 739 resident (43.1 %) respondents, industry-sponsored gifts were common, rising from 33.0 % (first-year students) to 56.8 % (fourth-year students) and 54 % (residents) (p?<?0.001). These gifts included meals outside the hospital (reported by 5 % first-year students, 13.4 % fourth-year students, 27.5 % residents (p?<?0.001)) and free drug samples (reported by 7.4 % first-year students, 14.1 % fourth-year students, 14.3 % residents (p?<?0.001)). The perception that industry interactions lead to bias was prevalent, but the belief that physicians receive valuable education through these interactions increased (64.1 % to 67.5 % to 79.8 %, p?<?0.001). Students in schools receiving more NIH funding reported industry gifts less often (OR?=?0.51, 95 % CI: 0.38-0.68, p?<?0.001), but the strength of institutional conflict of interest policies was not associated with this variable.ConclusionsDespite recent policy changes, a substantial number of trainees continue to receive gifts from pharmaceutical representatives. We found no relation between these outcomes and a school's policies concerning interactions with industry.
| S-EPMC3710396 | biostudies-literature
Project description:Relationships between health professionals and pharmaceutical manufacturers can unduly influence clinical practice. These relationships are the focus of global transparency efforts, including in Europe. We conducted a descriptive content analysis of the transparency provisions implemented by February 2017 in nine European Union (EU) countries concerning payments to health professionals, with duplicate independent coding of all data. Using an author-generated, semi-structured questionnaire, we collected information from each disclosure policy/code on: target industries, categories of healthcare professionals covered, scope of payments included, location and searchability of the disclosed data. Our analysis shows that although important improvements have been put in place in the past few years, significant gaps remain in disclosure requirements and their implementation. The situation differs substantially from country to country and the most striking differences are between governmental and self-regulatory approaches, especially with regard to the comprehensiveness of the disclosed data. In many cases, individuals can still opt out and reporting is incomplete, with common influential gifts such as food and drink excluded. Finally, in several countries data are only available as separate PDFs from companies, thus making the payment reports difficult to access and analyse. In order to overcome these gaps, minimum standards for disclosures should be implemented across Europe. All payments to healthcare professionals and organizations should be included, all health-related industries should be required to submit reports, and usability of disclosed data should be guaranteed.
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Project description:Although corporate social responsibility (CSR) activities are common in the pharmaceutical industry, there is little empirical evidence on consumer responses to CSR practices. We investigated public awareness, preferences, and expectations regarding social contribution of the pharmaceutical industry's CSR activities, and identified the factors associated with such activities. We conducted an online survey with 1,298 respondents comprising two groups: healthy individuals (546) and patients (752). Most respondents (78%) expressed interest in CSR activities undertaken by pharmaceutical companies. However, they reported a lack of awareness and experience thereof; only 26.9% were aware of and 7.9% had experience with such activities. Among our six CSR activity categories, both survey groups showed the highest preference for the "promoting public health" (healthy group: 6.34/10; patient group: 6.37/10) and "emergency disaster relief support" (6.31 and 6.35) categories. Among sub-categories, activities related to "development of innovative drugs in untreated areas" (6.63 and 6.82) and "support for research on new drug development" (6.59 and 6.84) received the highest scores. The mean expectation score of social contribution of all CSR activities was slightly higher than the mean preference score (6.37 and 6.06, respectively). The patient group exhibited a larger difference between the highest and lowest expectation scores than the healthy group (1.11 and 0.64, respectively). The results of the regression analysis revealed that being a patient, being male, and having positive attitudes toward CSR and its expected effects significantly and positively affected public preferences regarding CSR activities. We can conclude that CSR activities with high public preference might be an effective strategy to improve public awareness of the pharmaceutical industry's CSR activities. Furthermore, the highest preference for CSR activities relates to new drug development, indicating that our society believes the pharmaceutical industry's key CSR activity should be to pursue its intrinsic mission: to fulfill unmet medical needs by developing new drugs.
| S-EPMC6701779 | biostudies-literature
Project description:OBJECTIVES:To examine the under-reporting of pharmaceutical company payments to patient organisations by donors and recipients. DESIGN:Comparative descriptive analysis of payments disclosed on drug company and charity regulator websites. SETTING:UK. PARTICIPANTS:87 donors (drug companies) and 425 recipients (patient organisations) reporting payments in 2012-2016. MAIN OUTCOME MEASURES:Number and value of payments reported by donors and recipients; differences in reported payments from/to the same donors and recipients; payments reported in either dataset but not the other one; agreement between donor-recipient ties established by payments; overlap between donor and recipient lists and, respectively, industry and patient organisation data. RESULTS:Of 87 donors, 63 (72.4%) reported payments but 84 (96.6%) were mentioned by recipients. Although donors listed 425 recipients, only 200 (47.1%) reported payments. The number and value of payments reported by donors were 259.8% and 163.7% greater than those reported by recipients, respectively. The number of donors with matching payment numbers and values in both datasets were 3.4% and 0.0%, respectively; for recipients these figures were 7.8% and 1.9%. There were 24 and 3 donors missing from industry and patient organisation data during the entire study period, representing 38.1% and 3.6% of those in the respective datasets. The share of donor-recipient ties in which industry and patient organisation data agreed about donors and recipients was 38.9% and 68.4% in each dataset, respectively. Of 63 donors reporting payments, only 3 (4.8%) had their recipient lists fully overlapping with patient organisation data. Of 200 recipients reporting industry funding, 102 (51.0%) had their donor lists fully overlapping with industry data. CONCLUSIONS:Both donors and recipients under-reported payments. Existing donor and recipient disclosure systems cannot manage potential conflicts of interest associated with industry payments. Increased standardisation could limit the under-reporting by each side but only an integrated donor-recipient database could eliminate it.
| S-EPMC7511620 | biostudies-literature
Project description:IntroductionThe Physician Payment Sunshine Act was enacted to increase the transparency of financial relationships between physicians and the pharmaceutical industry. These financial relationships are prevalent in the field of oncology, as they are in other fields of medicine. We explored the relationship between industry and urologists for compensations associated with the treatment of urologic malignancies.MethodsThe publicly available Open Payments database was obtained from the Centers for Medicare & Medicaid Services. We performed a descriptive analysis of payments made to urologists for drugs associated with urologic malignancies.ResultsIn total, 44,334 payments, summing to $ 4,638,856, were made to 5,666 urologists for drugs used to treat urologic cancers. The median payment per transaction was $14, and most (74.3%) were £ $20. Of the transactions, 39,368 (88.8%) were associated with drugs for prostate cancer, 3,475 (7.8%) for bladder cancer, and 1,491 (3.4%) for kidney cancer. Most payments were made the form of food or beverage (89%), equating to $826,667.ConclusionsFor urologists, industry payments associated with cancer treatment are prevalent. Treatments for prostate cancer are associated with the most financial relationships, followed by bladder cancer and kidney cancer. Payments are small in amount, and are commonly in the form of food or beverage.
| S-EPMC8171588 | biostudies-literature
Project description:ImportanceMedicare recently launched the Physician Value-Based Payment Modifier (PVBM) Program, a mandatory pay-for-performance program for physician practices. Little is known about performance by practices that serve socially or medically high-risk patients.ObjectiveTo compare performance in the PVBM Program by practice characteristics.Design, setting, and participantsCross-sectional observational study using PVBM Program data for payments made in 2015 based on performance of large US physician practices caring for fee-for-service Medicare beneficiaries in 2013.ExposuresHigh social risk (defined as practices in the top quartile of proportion of patients dually eligible for Medicare and Medicaid) and high medical risk (defined as practices in the top quartile of mean Hierarchical Condition Category risk score among fee-for-service beneficiaries).Main outcomes and measuresQuality and cost z scores based on a composite of individual measures. Higher z scores reflect better performance on quality; lower scores, better performance on costs.ResultsAmong 899 physician practices with 5?189?880 beneficiaries, 547 practices were categorized as low risk (neither high social nor high medical risk) (mean, 7909 beneficiaries; mean, 320 clinicians), 128 were high medical risk only (mean, 3675 beneficiaries; mean, 370 clinicians), 102 were high social risk only (mean, 1635 beneficiaries; mean, 284 clinicians), and 122 were high medical and social risk (mean, 1858 beneficiaries; mean, 269 clinicians). Practices categorized as low risk performed the best on the composite quality score (z score, 0.18 [95% CI, 0.09 to 0.28]) compared with each of the practices categorized as high risk (high medical risk only: z score, -0.55 [95% CI, -0.77 to -0.32]; high social risk only: z score, -0.86 [95% CI, -1.17 to -0.54]; and high medical and social risk: -0.78 [95% CI, -1.04 to -0.51]) (P?<?.001 across groups). Practices categorized as high social risk only performed the best on the composite cost score (z score, -0.52 [95% CI, -0.71 to -0.33]), low risk had the next best cost score (z score, -0.18 [95% CI, -0.25 to -0.10]), then high medical and social risk (z score, 0.40 [95% CI, 0.23 to 0.57]), and then high medical risk only (z score, 0.82 [95% CI, 0.65 to 0.99]) (P?<?.001 across groups). Total per capita costs were $9506 for practices categorized as low risk, $13?683 for high medical risk only, $8214 for high social risk only, and $11?692 for high medical and social risk. These patterns were associated with fewer bonuses and more penalties for high-risk practices.Conclusions and relevanceDuring the first year of the Medicare Physician Value-Based Payment Modifier Program, physician practices that served more socially high-risk patients had lower quality and lower costs, and practices that served more medically high-risk patients had lower quality and higher costs.
| S-EPMC5817610 | biostudies-literature