Industry reports payments of $18 million to doctors of optometry in 2014, according to study

Industry reports payments of $18 million to doctors of optometry in 2014, according to study

"After considering all the evidence, it should be up to each individual optometrist to decide what kind of relationships they are comfortable having."

In an era of growing transparency, a new study looks at publicly reported data showing the payments doctors of optometry received from drug and device makers and group purchasing organizations (GPOs) in 2014.

Among the findings of the study, which covered data from Jan. 1 to Dec. 31, 2014:

  • 165,035 transactions were made to more than 36,000 doctors of optometry who received at least one payment
  • $18,289,816.66 was paid through those transactions
  • Of that total, $13,166,996.34 went to 10 percent of recipients
  • The average total payment over the entire time frame, per physician identifier, was valued at $502; they ranged in value between $1 and $406,392.

"The goal of the project was to increase awareness of these financial relationships," says lead researcher Erik Mothersbaugh, O.D., assistant professor of optometry at the Illinois College of Optometry and clinical attending physician at the Illinois Eye Institute in Chicago. Additional study authors include Elizabeth Wyles, O.D., and Jordan Keith, O.D.

Under the Sunshine Act—also known as the Open Payments program—drug and device makers and GPOs must disclose payments or gifts to doctors of optometry and other doctors on an annual basis. The program, administered by the Centers for Medicare & Medicaid Services (CMS), is intended to provide transparency. Some are concerned that financial relationships between physicians and the medical industry can create conflicts of interest for physicians that potentially impact patient care. Data is available for public view on CMS' website. On June 30, CMS is expected to release 2015 data to the public.

Publicly reported payments received by doctors include:

  • Cash or cash equivalent
  • In-kind items or services
  • Stocks, or stock options, or any other ownership interest, dividend, profit or other return on investment
  • Any other form of payment or other transfer of value

Other permissible gifts might include travel and lodging, grants, consulting fees, honorarium, education, and food and beverages.

The study analyzing transactions between drug and device makers/GPOs and doctors of optometry focuses on gifts and does not include research and ownership payments.

There does not appear to be any data comparing payments to doctors of optometry and ophthalmologists over the same time frame. However, a study, "The Physician Payments Sunshine Act: Data Evaluation Regarding Payments to Ophthalmologists," by Jonathan Chang, M.D., published last year in the online journal Ophthalmology, looked at payments to ophthalmologists from Aug. 1, 2013 through Dec. 31, 2013—the first reporting period made public under the CMS transparency program.

Among its findings relative to ophthalmologists over the five-month period:

  • 55,996 transactions were made to 9,855 ophthalmologists
  • Those payments were valued at $10,926,447
  • The average total payment over the entire time period, per physician identifier, was valued at $1,108; they ranged in value between $1 and $397,849.

An important conversation for doctors of optometry
The Sunshine Act does not prohibit these financial relationships; in fact, they are called mutually beneficial.

"Collaborations among the medical product industry, physicians and teaching hospitals contribute to the design and delivery of life-saving drugs, devices, biologicals, and medical supplies," the January 2016 CMS Open Payments user guide states.

Still, some studies have linked these gifts to the prescribing behavior of doctors, including a March 17 report by ProPublica. ProPublica analyzed the prescription patterns of doctors who wrote at least 1,000 prescriptions in 2014 under Medicare's drug program (Part D). Among other things, the report looked at five specialties: psychiatry, cardiovascular disease, family medicine, internal medicine and ophthalmology. Among those specialties, the link between gifts to ophthalmologists and brand-name prescribing were the strongest. For patients, the costs of brand-name drugs are higher than generic pharmaceuticals.

The study on doctors' of optometry payments does not make these links. But its lead author believes it's an important conversation to have.

"When we say that the goal of this project is to increase awareness of these relationships, it's in hope that, after seeing the data, more optometrists may then be open to entertaining the existing evidence in the literature," Dr. Mothersbaugh says. "My opinion is that, in order to protect patients, we have a responsibility to understand the full implications before agreeing to participate in these financial relationships with industry."

He adds, "Then, after considering all the evidence, I believe it should be up to each individual optometrist to decide for themselves what kind of relationships they are comfortable having."

AOA's Standards of Professional Conduct address issues of potential conflicts of interest. Click here to learn more.

Continuing education featuring the latest research
The study, "The Sunshine Act First Year Results: The Status of Optometry," was selected by AOA's Poster Committee to be featured in an interactive session called "Current Research You Should Incorporate Into Your Mode of Practice Now," which will take place at Optometry's Meeting® in Boston, Massachusetts, on Saturday, July 2, from 8 a.m. to 10 a.m. Click here to see the poster abstract and other abstracts that are part of AOA's 2016 Poster Session.

June 8, 2016

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