As the Affordable Care Act enters its second year of offering health care exchanges, it brings to light the financial links between patients’ doctors and the medical industry.
The Physician Payment Sunshine Act, passed in 2010 as a provision of the ACA, requires payments and gifts that physicians receive from corporations to be made publicly available for the first time. A website with all the information about payments, titled Open Payments, launched on Sept. 30. According to data compiled by the Centers for Medicare and Medicaid 5,400 Connecticut physicians received a total of $6 million for various services to pharmaceutical and medical device companies. Three of the highest paid physicians in the state of Connecticut were affiliated with Yale. Still, New Haven medical practitioners and industry experts said the unprecedented release of information will not have a discernible effect on doctor-patient relationships.
“My gut feeling is that patients won’t know what to do with the data,” Yale School of Medicine Dean Robert Alpern said.
Patients are unlikely to engage with the “fiddly” and unintuitive web interface, which does not provide specific information about the nature of the payments, Alpern said. Peter Swenson, a political science professor who specializes in the politics and economics of health care, agreed that the act will have “virtually no effect on patient behavior.”
Even if the act has little effect, industry experts conceded that most medical professionals are not overwhelmingly supportive of the act because they because they believe it can lead to ambiguous interpretations. Alpern, one of the three physicians in Connecticut receiving the highest amount in reimbursements from pharmaceutical companies, explained that the data set does not differentiate between various types of financial interactions in which doctors partake, especially at research universities and teaching hospitals.
“If a grant comes to Yale for a doctor to do a clinical trial, those dollars show up as though they are a salary — and those two things are totally different,” Alpern said.
School of Medicine professor Bridget Martell and Richard Lifton, chair of the department of genetics and internal medicine at the medical school, were the two other Yale-affiliated doctors featured among the 10 highest-paid physicians in the state of Connecticut.
Howard Forman, School of Medicine professor and director of the MD-MBA program, warned that the information could lead patients to make incorrect conclusions about the incentives under which their physicians operate.
“Some individuals may see ‘oh, my doctor got paid $400,000 this year — he must be an expert,’ while others would think ‘he got paid $400,000 this year — he got bought off,” he said.
According to Alpern, the intentions behind the act came from a good place, but since so few doctors are unduly influenced by payments from pharmaceutical companies, the law may not have as great an impact as envisioned. While a small number of doctors will make decisions that inappropriately align with the interests of the companies filling their wallets, those are the doctors that get the headline stories, he added.
Nevertheless, physicians interviewed agreed that transparency is a vital component of functional health care systems.
“People have the right to know this information,” Forman said.
At Yale, strict policies prohibiting faculty from engaging in speakers bureaus — sponsored talks in which academic physicians promote the products of pharmaceutical companies under the guise of educational talks — have historically minimized conflicts of interest between physicians and outside companies.
According to Swenson, the act was intended to impact more than just patients. He said it will impact the marketing practices of drug companies, including their willingness to pay doctors for promotional activities “disguised as information and education [talks] about new, expensive and possibly not very effective drugs.” According to Forman, the new data could also give insurance companies an indication of which physicians are likely to be high or low cost providers.
And having information on all of those things is a net plus, he said.
“In a social networking able world, increasingly, people look to Yelp for restaurant reviews and similar websites for the input of others,” Swenson said. “We rely very much on information that others provide.”
Because this is the first time such detailed information is being made available, it is unclear how hospitals like Yale-New Haven will be impacted, he said.
“At this point, all we can do is speculate.”
The Physician Payment Sunshine Act was first introduced in 2007 by Senator Chuck Grassley (R-IA) and then Senator Herb Kohl (D-WI).