Industry Financial Relationships in Neurosurgery in 2015: Analysis of the Sunshine Act Open Payments Database.

OBJECTIVE: The 2013 Physician Payments Sunshine Act mandates that all U.S. drug and device manufacturers disclose payments to physicians. All payments are made available annually in the Open Payments Database (OPD). Our aim was to determine prevalence, magnitude, and nature of these payments to physicians performing neurologic surgery in 2015 and to discuss the role that financial conflicts of interest play in neurosurgery. METHODS: All records of industry financial relationships with physicians identified by the neurological surgery taxonomy code in 2015 were accessed via the OPD. Data were analyzed in terms of type and amounts of payments, companies making payments, and comparison with previous studies. RESULTS: In 2015, 83,690 payments (totaling $99,048,607) were made to 7613 physicians by 330 companies. Of these, 0.01% were >$1 million, and 73.2% were <$100. The mean payment ($13,010) was substantially greater than the median ($114). Royalties and licensing accounted for the largest monetary value of payments (74.2%) but only 1.7% of the total number. Food and beverage payments were the most commonly reported transaction (75%) but accounted for only 2.5% of total reported monetary value. Neurologic surgery had the second highest average total payment per physician of any specialty. CONCLUSIONS: The neurological surgery specialty receives substantial annual payments from industry in the United States. The overall value is driven by a small number of payments of high monetary value. The OPD provides a unique opportunity for increased transparency in industry-physician relationships facilitating disclosure of financial conflicts of interest.

An Analysis of the Open Payment Database in Neurotology.

Since the introduction of the Sunshine Act in 2010 and Open Payments Database (OPD) in 2013, a significant amount of data has been collected on physicians and the payments received through ties with pharmaceutical and medical device companies. To date, a study within the field of otology and neurotology using data from the 2015 OPD has not been conducted. As such, we assessed the validity and accuracy of OPD information for otologists and neurotologists (O&Ns). Of the 126 physicians listed as O&Ns in the OPD, 25 were actually general otolaryngologists, and 1 was a cardiologist. In addition, 88 O&Ns were misclassified by the OPD as general otolaryngologists. A total of 1156 payments, summing $1,966,204, were made to O&Ns as a whole, with 646, 507, and 3 payments classified as general, research, and ownership/investment interests, respectively. Analysis of OPD data for O&Ns demonstrates a significant financial relationship between O&N physicians and industry, as well as noteworthy inaccuracies in the OPD that likely affect other subspecialties.

A Look at MACRA: What to Expect in 2017.

The Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act of 2015 fundamentally changes how physicians who care for Medicare patients will be paid. Although physicians won't see changes in their payments in 2017, they need to understand that their performance in 2017 will be the basis for the payments made to them starting in 2019. This article summarizes the two paths for determining future Medicare payments established by the law: the merit-based incentive payment system and advanced alternative payment models.

Getting value from health spending: going beyond payment reform.

It is widely held that fee-for-service (FFS) payment systems reward volume and intensity of services, contributing to overall cost inflation, while doing little to reward quality, efficiency, or care coordination. Recently, The National Commission on Physician Payment Reform (sponsored by SGIM) has recommended that payers "should largely eliminate stand-alone fee-for-service payment to medical practices because of its inherent inefficiencies and problematic financial incentives." As the current and former Chief Medical Officers of a large national insurer, we agree that payment reform is a critical component of health care modernization. But calls to transform payment simultaneously go too far, and don't go far enough. Based on our experience, we believe there are several critical ingredients that are either missing or under-emphasized in most payment reform proposals, including: health care is local so no one size fits all; upgrading performance measures; monitoring/overcoming unintended consequences; using a full toolbox to achieve transformation; and ensuring that the necessary components for successful delivery reform are in place. Thinking holistically and remembering that healthcare is a complex adaptive system are crucial to achieving better results for patients and the health system.

The Medicare audit and appeals process: a guide for interventional pain practitioners.

BACKGROUND: Health care is a highly regulated industry and interventional pain physicians (IPPs) are right in the government's bull's eye. Over the next few years, IPPs will find themselves responding to audit requests from Medicare. An IPP's response to a Medicare record request should be tailored specifically to the type of request and the specific circumstances of the IPP. With so much at stake, IPPs should not underestimate the importance of an immediate and thoughtful response. OBJECTIVES: This article discusses 1) the various types of record requests used by Medicare, 2) the practical steps an IPP should take in response to a record request, 3) the Medicare appeals process, and, 4) the practical steps an IPP should take in connection with the appeals process. DISCUSSION: IPPs should maintain an effective compliance program and ensure that medical records are appropriately documented before any audit takes place. If a Medicare audit decision is unfavorable, IPPs should understand the available appeals process and the steps that need to be taken to win the appeal. CONCLUSION: With advance preparation and a considered response, IPPs can positively influence the outcome of a Medicare audit.

Termination of the Prospective Payment Assessment Commission and the Physician Payment Review Commission--GAO. Notice of termination of commissions.

The Balanced Budget Act of 1997 requires the Comptroller General, after the Medicare Payment Advisory Commission has been established, to provide for the termination of the Prospective Payment Assessment Commission and the Physician Payment Review Commission. This notice announces the termination of the two commissions.

Physician behavioral response to a Medicare price reduction.

OBJECTIVE: To investigate at the individual practice level physician behavioral responses to the Medicare fee reductions mandated in the Omnibus Budget Reconciliation Act of 1989. Symmetric and nonsymmetric behavioral responses are modeled and investigated. DATA SOURCES: Volume index calculated from data in the Part B Medicare Annual Data (BMAD) Provider Files for 1989 and 1990. The pricing data are from the Procedure Files. STUDY DESIGN: A fixed-effects model in carrier and in specialty is employed. DATA COLLECTION: No direct data collection is required as BMAD files are used in the study. Price and volume variables are expressed as Fisher indexes of change. PRINCIPAL FINDINGS: The results show nonsymmetrical behavioral response because practices that did not face significant fee reductions do not exhibit behavioral change. By contrast, losers partially compensate for the fee reductions. For every dollar cut in their fees, physicians recoup approximately 40 cents by increasing volume. Loser behavioral responses vary by specialty. CONCLUSIONS: The presence of a volume response suggests that price control alone is not sufficient to cap rising healthcare costs. This indicates that additional or other tools must be considered if cost containment is to be attained.