Primary care least likely to receive industry payments, Massachusetts study shows

Primary care was among the specialties least likely to receive payments from the medical device and pharmaceutical industries, according to an analysis of Massachusetts' records of industry financial relationships with physicians.

Between July 2009 and December 2011, industry payments went to 19% of that state's nonspecialist internists, 21% of family physicians, and 12% of pediatricians. That compares with 61% of urologists, 57% of gastroenterologists, 51% of rheumatologists, and 46% of cardiologists.

Overall, about 25% of physicians in the state received industry gifts or payments that were valued at $50 or more, according to research published in the New England Journal of Medicine (NEJM).

In 2009, Massachusetts required drug and device companies to report to its Department of Health and Human Services payments of $50 or more. The Massachusetts law is a preview of sorts of the federal Physician Payment Sunshine Act, which is scheduled to take effect August 1.

Under the Sunshine Act, drug and device companies must report payments of more than $10 to the Centers for Medicare and Medicaid Services (CMS), which is scheduled to post that data on its Web site by September 30, 2014.

The authors of the NEJM study speculated that one of the reasons primary care physicians were among the least likely to appear in the payment reports is that they may receive many gifts valued at less than $50 that are not reported in the Massachusetts database.

The NEJM study found that 30 months' worth of data included 32,227 reported payments to 11,734 Massachusetts physicians, for a total of $76.7 million. In 2011, the average total payment per physician over the course of the year was a little less than $5,000.

The most common form of payment was food, whereas the payment type with the highest value ($67.3 million out of the $76.7 million total) was compensation for "bona fide services," which primarily refers to consulting and speaking fees.

To prepare for the Sunshine Act, attorney Julie Treumann, JD, recommends physicians take the following steps:

Assess your relationships with manufacturers and ask whether they are subject to the Sunshine Act reporting requirements.

Decide whether to accept the payments or transfers of value, or maintain the ownership interests, that would result in the financial relationship being made public.

Each time you are approached or offered a payment or something of value, ask whether acceptance will result in reporting under the Sunshine Act-which the manufacturer and its representatives should know-to be fully informed about how such acceptance will be disclosed and how it could be perceived by patients, employers, and potential purchasers of your practice.

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