Transparency. President Barack Obama felt it important enough to publish a Memorandum for the Heads of Executive Departments and Agencies in the Federal Register . He writes that “Openness will strengthen our democracy and promote efficiency and effectiveness in Government.” The Accountable Care Act indeed incorporates this principle into one aspect of medical care generally hidden from view…….money that flows from health care companies to physicians.


According to the Center for Medicare and Medicaid Services (CMS), “Practitioners and teaching hospitals received at least $3.5 billion in payments in the last five months of 2013, …. Speaking and consulting fees accounted for roughly $380 million. Some physicians took home more than $500,000. Those eye-popping amounts confirm the potential for serious ethical conflicts.”


Many folks are jumping on the band wagon. A Chicago Tribune Editorial notes that “Patients should know if docs who prescribe a certain drug, order a certain test or implant a certain device have a financial interest that could influence their decisions.” <chicago tribune,=”” october=”” 2,=”” 2014=””>


This has become known and knowable through the Open Payments Program, a data base set up under the auspices of CMS that requires businesses to report their payments to physicians for a wide variety of functions…….exclusive of patient care. The following is from the CMS website:


Applicable manufacturers of at least one covered drug, device, biological, or medical supply must report all payments or other transfers of value provided to covered recipients, regardless of whether any particular payment or other transfer of value was related to a covered drug, device, biological, or medical supply. Applicable manufacturers will be required to categorize all reportable payments as falling within one of the following natures of payment:


  • Consulting fees
  • Compensation for services other than consulting, including serving as faculty or as a speaker
  • Honoraria
  • Gifts
  • Entertainment
  • Food and beverage
  • Travel and lodging
  • Education
  • Research
  • Charitable contributions
  • Royalty or license
  • Current or prospective ownership or investment interest
  • Compensation for serving as faculty or as a speaker for an unaccredited CME program
  • Compensation for serving as faculty or as a speaker for an accredited CME program
  • Grants
  • Space rental or facility fees (teaching hospital only)


Health Care Facilities have begun to explore this database to understand conflicts of interest that physicians may have when recommending new equipment to management for purchase. Universities have begun to look at the information to confirm the accuracy of financial conflict of interest disclosures by faculty and to consider broadening their concepts of conflicts of interest.


The information in its first release has significant flaws. Monies may not be reported in the correct category. About a third of the reports from industry were redacted for concerns over accuracy.


Physicians are concerned about the publication of the data for a variety of reasons:


  1. The Review and Dispute processes permitting them to object to the report’s payments are cumbersome.
  2. The Public and Media are not well educated about the information, and the context for payments is not clear from the data itself.
  3. The reporting requirements are not uniformly applied across the reporting industries.


CMS is scrambling to improve the data……….but it’s there……….now…………..and searchable:

As the Tribune concluded: “Despite its serious flaws, Open Payments provides enough information to show that more disclosure of the financial links between doctors and health care companies is sorely needed.”


If you are a physician, make sure the data is correct. If you are a hospital administrator, you may find the information interesting. If you are a consumer………buyer beware…….ask your physician about his or her involvement, and how they may view the potential conflicts posed by their activities.




Memo on Transparency: Office of the White House


Tribune article: What doctors really make.


Fact Sheet for Physicians: