By Marla Durben Hirsch, contributing writer
You may want to think twice about whether the pizza your office receives from a pharmaceutical company sales rep is worth its long-term cost. A new study has found that even the smallest of gifts can influence prescribers’ prescribing habits. And don’t forget: the pharmaceutical manufacturer has to report those gifts to HHS, which posts them on the internet for everyone to see.
The Open Payments program, created by the Affordable Care Act, requires pharmaceutical and medical device manufacturers to report to HHS all payments and “transfers of value” made to physicians and academic medical centers. The goal is to increase transparency so that providers’ professional judgment is not swayed by such gifts and enable patients to make more informed decisions about their providers. While many financial relationships between prescribers and manufacturers are beneficial, they can sometimes lead to conflicts of interest and undue influence on the provider, HHS points out.
The list of reportable payments is broad, and includes consulting fees, research grants, food and beverages, travel, entertainment, education, honoraria, promotional items, textbooks, and charitable contributions. The threshold is low; in 2017 the value of an individual item need only be $10.32 or have a cumulative total of $103.22 for the year to be reportable.
According to HHS’ website, to date there have been $8.18 billion in gifts reported since the program began in 2013. Fully 631,000 physicians in the United States have received some sort of payment.
Often prescribers deny that they can be swayed this way, but the study found otherwise.
Gifts of all sizes have an impact
The study, funded by the District of Columbia Department of Health and published in PLOS One, reviewed payments reported to the Open Payments program and Washington, DC’s reporting program against Medicare Part D data. It found almost 40 percent of DC providers had received some sort of gift, ranging from $7.00 to more than $200,000 during the period reviewed.
More notably, the gifts from pharmaceutical companies were associated with more prescriptions per patient, more expensive prescriptions ordered, and a higher proportion of brand name drugs prescribed. For example:
- Gift recipients prescribed more than twice as many drugs as those that didn’t receive gifts
- Gift recipients prescribed 7.8 percent more brand name drugs
- Even doctors who received insignificant gifts, like donuts, had more expensive claims and prescribed more brand name drugs; doctors who accepted larger gifts (more than $500 a year) had even more expensive claims and prescribed fewer generics
“This study clearly shows that even small gifts change the practice of medicine,” said one of the study co-authors in a statement. “Gifts, no matter their size, have a powerful effect on human relationships, and pharmaceutical companies are well aware of that.”
Why prescribers should take notice
With the increased scrutiny of prescriptions for opioids and of the overall cost of medications, expect this issue to receive more media attention in the coming months.
Also expect the Open Payments website to receive more traffic from the public – including government investigators, patients’ attorneys and journalists – who are curious about the relationships between providers and pharmaceutical companies.
And to top it off, the government is so concerned about whether these gifts are unlawful and/or affecting patient care that HHS’ Office of Inspector General added these payments to its list of issues it will investigate. Its report is expected in 2018 and may lead to even more digging into these payments.
Now is a good time for physicians and other prescribers to review their prescribing habits as well as their dealings with these companies. Consider these steps:
1. Assess any financial relationship you have with pharmaceutical and device manufacturers and make sure that they are legitimate. For instance, if you’re being paid a consulting fee, you should be providing actual consulting services, and the compensation for it should be reasonable.
2. If you are receiving gifts or are in some sort of financial relationship, consider whether it’s worth it, remembering that most of them will be reported to the government.
3. Go to the Open Payments website and look yourself up. See what, if any, reports have been made about you (registration is free). If so, review them to ensure that they are accurate. Mistakes have been made, including reports attributed to the wrong physician or the wrong amounts reported.
4. If you believe a mistake has been made, consider challenging the report, which is allowed but subject to timing and other restrictions.
5. Confirm whether there are other limits on your ability to accept these payments. For example, some hospitals have banned members of the medical staff from accepting gifts of more than a token amount.