Ben Philipson

At the end of June, CMS made available Open Payments data for 2014 detailing information on 11.4 million financial transactions totaling $6.49 billion attributed to over 600,000 physicians and more than 1100 teaching hospitals from medical device and drug manufacturers.

The purpose of the Open Payments database is to increase transparency and provide consumers with more information to aid in their decision making. However, there is a flaw with the system: the data largely excludes nurse practitioners (NPs) and physician assistants (PAs).

In fact, the same month that CMS released Open Payments data for 2014, a NP pled guilty to taking $83,000 in kickbacks from a drug company in exchange for prescribing the company’s high-priced cancer treatment, according to NPR.

NPs and PAs are playing larger roles in the care of patients and are becoming increasingly authorized to write prescriptions, and yet companies are not required to report payments to these care providers.

ProPublica analyzed prescribing patters in Medicare Part D and determined that NPs and PAs wrote 10% of prescriptions in the prescription drug program in 2013.

The Open Payments database was created as part of the Physician Payments Sunshine Act, which was part of the Affordable Care Act, signed into law in 2010. When the Sunshine Act was being created, nursing groups simply weren’t part of the conversation, according to NPR. However, a 2010 study in The American Journal of Managed Care found that NPs who can prescribe have a high rate of contact with pharmaceutical industry promotional activities.

Of the NPs who participated in the study, 66% dispensed drug samples regularly to their patients, 81% thought it was ethically acceptable to give out samples to anyone, and 91% thought it was acceptable to attend lunch and dinner events sponsored by the pharmaceutical industry.

“This finding raises a concern because the respondents also noted that they were more likely to prescribe a highlighted drug after attending an industry-sponsored meal event,” Elissa C. Ladd, PhD, RN, FNP-BC, and colleagues concluded. “These data further support evidence from the medical and social science literature that gifting of any kind, even of small items such as pens, snacks, or meals, influences prescribing behaviors.”