Open Payments data shows physician-industry relationships less common in radiology

Radiologists had fewer reportable non-research-related, physician-industry financial relationships than most other medical specialties, according to a recent article published by the Journal of the American College of Radiology.

H. Benjamin Harvey, MD, of the department of radiology at Massachusetts General Hospital in Boston, and colleagues examined CMS Open Payments data from August 2013 to December 2013, noting the frequency and value of radiology-related transfers and comparing those statistics with other specialties. Examples of the physician-industry financial relationships included in Open Payments data are pharmaceutical drug samples, consulting or lecturing fees, event tickets, and complimentary meals.

Overall, the authors found that 7.4% of U.S. radiologists had reportable non-research-related, physician-industry financial relationships during the five-month time period, the second-lowest total among the 20 specialties that were studied.

Harvey spoke with about the team’s findings and said he had expected radiology to rank low compared to other specialties, due to the very nature of how radiologists practice.

“Since a lot of money that comes into interactions between physicians and industry surround pharmaceuticals, and radiologists don’t prescribe very many pharmaceuticals, it didn’t surprise me that there wasn’t as high of a relative percentage of radiologists with interactions compared to those specialties that do much more prescribing,” Harvey said. “We did see, as one would expect, that when physician-industry interactions were occurring in radiology, they were much more likely to be centered around devices, including imaging equipment and medical devices used by interventional radiologists.”

The statistic Harvey is referencing shows that over 77% of all non-royalty-based transfers of value found within the Open Payments data was related to medical devices, and just over 8% were related to pharmaceuticals.

State by state

Harvey and his colleagues also looked at how many radiologists received qualified value transfers in each state (radiologists practicing in more than one state were filed by their “primary state of medical licensure”) and the data showed a significant difference from one state to the next.

The states with the highest percentage of radiologists with reportable non-research-related, physician-industry financial relationships included Oklahoma (16.2%) and Washington, D.C. (13.7%). Vermont had the smallest percentage (0%), while Delaware, Wisconsin, Iowa and Wyoming all came in at 2.5% or less.

Harvey said these numbers don’t necessarily mean radiologists in the states with higher percentages are doing anything different than radiologists anywhere else, and that those state differences can often be attributed to specific outliers. He did, however, note that Vermont having no reportable relationships is a direct result of the state’s Prescribed Product Gift Ban and Disclosure Law.

“Vermont’s law is undoubtedly, if you look across the country, the strongest law with regards to trying to reduce industry-physician interactions,” Harvey said. “And as our data suggest, it is the most effective in terms of radiology. The importance of that disclosure law is that it specifically pertains to both drugs and devices. Compare that with Washington, D.C., which also has a strong disclosure law, but that law only pertains to drugs.”

Looking closer at leadership positions

The average radiologist with a non-research-related interaction received just under $438 of aggregate value, which ranked No. 12 out of the 20 specialties that were examined. Most radiologists received a total value of less than $50, but 45 radiologists received a total value of over $5,000, and 26 of those 45 held leadership positions at an academic or private imaging enterprise.

Does this suggest something dishonest is happening with radiologists in leadership positions? Harvey doesn’t believe so.

“I don’t suspect there’s anything nefarious about it,” Harvey said. “Why are these people in leadership positions? It’s because they’ve defined themselves as thought leaders within their clinical fields. And by defining themselves as thought leaders, industry is naturally going to want to come to them and get their opinions. Their opinions hold the most value for industry.”

Weighing the data’s impact

Harvey said that the Open Payments data will likely make physicians look at financial relationships in a different way, especially because CMS makes it all public and so easy to find.

“Physicians are very sensitive to the way they’re viewed by their patients and the public,” Harvey said. “And now someone is going to post something that says, ‘you received $150 from Company X.' I think that this will make many radiologists think twice about whether that dinner sponsored by Company X is worth it or not. Is the free dinner worth the public disclosure?”

While he expects the data’s existence to make people think twice about low-value interactions such as complimentary meals, the data’s impact will be much smaller when it comes to larger interactions, like those based on consulting or public speaking.

“I don’t think it’s likely to significantly change the frequency of higher-value interactions, such as consulting interactions,” Harvey said. “In balance, the higher-value of these interactions may make it worth taking on the disclosure and potential conflict.”