Open Payments data for the calendar year of 2015 were obtained from https://www.cms.gov/openpayments. The database used in this investigation included general payments reported for the 2015 program year. General payments are defined by the CMS as gas reimbursement or other transfers of value made to a recipient (physician or teaching hospital) that were not connected with a research agreement or research protocol.⁵ Data sets with research payments and physician ownership and investment interest were excluded. Thus, this study's data set included all payments from GPOs to physicians or teaching hospitals. The data set did not include nonphysicians, and, as such, nonphysician professionals receiving payments were not included. After obtaining the data set, we excluded any physicians who were not specifically denoted as cardiologists, which also omitted payments made to cardiac electrophysiologists and interventional cardiologists defined by the CMS's health care provider taxonomy.⁸ Using the unique number of cardiologist IDs per CMS data set, we then computed the number of cardiologists documented in 2015. Statistics on these specific physicians were then performed, and they were further categorized. 

We next determined what types of payments were received by cardiologists and ranked the nature of payments received and their respective percentiles. We also determined which cardiovascular industries were most prominent in the data set. We calculated how many cardiologists participated in relationships with industry vs how many practiced per Association of American Medical Colleges, the payments made with their percentiles by geographic location, the total number of payments made and their dollar amount, the payment amount per category, and the medical industries incorporated. We then ranked cardiovascular manufacturers by total dollar amount while analyzing which type of payment was most prevalent. STATA 14 and Microsoft Excel 2016 were used for further data extrapolation and for more detailed analysis. 

With respect to all Open Payments data available for 2015, a total of 618,000 physicians in all specialties received a total payment amount of $7.52 billion, with 11.9 million payments made.⁶ In the 2015 calendar year, a total of 81,977 payments were made to 12,078 cardiologists, amounting to $13,906,167.43 and representing 0.2% of all payments accounted for that year. The minimum payment made to a cardiologist was $1.16, and the maximum payment was $2,805,825. The median amount received by a cardiologist in 2015 was $258.92. The payment categories included 12 distinct groups: charitable contribution; compensation for services other than consulting, including serving as faculty or as a speaker at a venue other than a continuing education program; compensation for serving as faculty or as a speaker for a nonaccredited and noncertified continuing education program; consulting fee; education; entertainment; food and beverage; gift; grant; honoraria; royalty or license; and travel and lodging. The category with the highest value was compensation for services other than consulting, including serving as faculty or as a speaker at a venue other than a continuing education program ($8,105,139.92). The second highest value category was consulting fees ($2,134,400.97), followed closely by food and beverage ($1,956,174.97). The category with the lowest value was gifts ($280.00). The distribution of all categories is presented in Table 1. 

A total of 45 GPOs submitted payments to a cardiologist. AstraZeneca Pharmaceuticals, LLC, was the submitting GPO with the highest overall payment submissions, which were valued at $7,211,860 and accounted for 51.85% of total payments to cardiologists. Biosense Webster, Inc, was the second highest, accounting for $3,486,735 (25.07%), followed by St. Jude Medical, Inc, with $884,122 (6.36%), ZOLL Services LLC with $836,769 (6.02%), and Thoratec Corporation with $709,814 (5.10%) (Figure). These top 5 medical corporations accounted for $13,129,300 (94.41%) of all payments to cardiologists. The top 25 companies’ total payments are presented in Table 2.The next step incorporated the range of payments in monetary value with their frequency to physicians, assessed in categories of less than $10; $11 to $50; $51 to $100; $101 to $500; $501 to $1000; $1001 to $5000; $5001 to $10,000; $10,001 to $15,000; $15,001 to $20,000; $20,001 to $25,000; and more than $25,000. The most frequent category was $11 to $50, with 53,722 payments (65.53%), followed by less than $10 with 12,307 (15.01%) payments made. More than 80% of all payments made were valued at less than $10. A decreasing trend in the amount of payments by medical industries was seen when payments above $5000 were made (Table 3). 

With the introduction of the PPSA, Open Payments data were first collected in August 2013. The main objective was to foster greater transparency of financial relationships between providers (physicians, hospitals) and medical industries; this transparency has been increasing each year since the first data set was released on September 30, 2014.⁹ In 2013, 4.09 billion dollars in 4.50 million payments was documented. In 2014, 7.86 billion dollars in 12.02 million payments was documented. The highest amount to date was reached in 2015, with 8.09 billion dollars in 12.3 million payments documented.⁹ The upward trend found within Open Payments has allowed for more clarity regarding the direction of the relationships between providers and medical industries. This clarity is reinforced by the data sets being available online and searchable by all consumers and health care providers without any restrictions or limitations. 

Total payments to cardiologists amounted to $13,906,167.43, with physicians of all specialties receiving $7.52 billion. Payments to the cardiac specialists was 0.18% of all payments made during 2015, which accounted for a miniscule amount in comparison with total payments made by medical industries to all physicians. According to AAMC data and reports,¹⁰ there were 22,058 active cardiologists practicing in 2015. Open Payments data show that 12,078 cardiologists received any payment in 2015, indicating that 54.76% of these specialists were involved with medical industries. 

Although payments received by cardiologists are a fraction of the overall payments reported within the Open Payments database, the effects these payments may have should not be discounted. DeJong et al¹ reported that even miniscule payments can directly affect physician prescribing and preferences, and these potentially unreported industry relationships could influence cardiologists’ decision-making. Furthermore, Andreatos et al¹¹ reported that cardiovascular clinical practice guidelines had the highest percentage (62.5%) of physicians receiving more than $5000 from a single company among all medical specialties. In addition, the authors¹¹ found that of physicians receiving greater than $5000 from a single company, only 7.0% correctly disclosed these payments within their guideline disclosure statement. This finding indicates that industry influence may bias (whether consciously or subconsciously) the prescribing practices of cardiologists, as well as the conclusions made within cardiovascular clinical practice guidelines. These findings also support the Open Payments' usefulness in evaluating industry relationships and the need for transparent reporting of industry relationships 

The CMS provides whole data sets on their website, which can be easily searched and examined. Although the data availability lends insight to financial ties, the current method of documenting some payments has limitations. Small payments defined by the law as less than $10 do not need to be reported unless the total annual value of payments provided to a physician or teaching hospital exceeds $100.⁴ This stipulation may indicate that not all relationships are being disclosed, although one can argue that the number of undisclosed relationships is small because the payment received by the average cardiologist is $258.92. Another limitation to this data reporting is that discounts, including rebates, do not need to be reported to the CMS. 

Although data reporting has been increasing, inconsistencies remain in Open Payments. The first release of CMS data contained $2.2 billion that went unverified by the associated physicians, owing to inaccuracies in their reporting systems. The data in Open Payments may have also undergone an unsatisfactory degree of prerelease vetting, as 4.8% of physicians and 29.8% of teaching hospitals underwent a complex vetting process.¹² Between 2015 and 2017, more than 98% of the total payments were validated with physician approval.¹³ This upward trend verifies the positive response to Open Payments and confirms that providers with financial ties to industry are confirming these ties. 

Because the data in the Open Payments database may place the reputation of physicians at stake, a more detailed explanation of the payments in the database may be warranted. Patients or others may misinterpret the data because of the small character field given for explanation of the payment. Furthermore, less than 10% of payments have a corresponding contextual commentary, leaving more than 90% of the disclosed payments up to open interpretation by the viewer.¹² 

Physicians should be aware of and familiar with the Open Payments system, and they should continue to compare their own documentation with what is posted in the system to ensure accuracy. Of the 81,977 payments available in the data set, 9 had a dispute status. This relatively minute dispute status either indicates that many physicians approve of the accuracy of the readily available data or suggests that physicians are not closely monitoring the payments associated with them. A more clear method is needed for further clarification. 

A statement from the American Medical Association¹⁴ released in June 2016 reported that physicians have a difficult time participating in the review and validation process of submitted data. They stated that the CMS website is “confusing, time consuming, and overly burdensome.”¹⁴ The organization also reported that physicians could be viewed in a negative light by patients if erroneous data are published. 

Currently, government officials are debating a possible repeal of the ACA. Repeal would threaten the Open Payments system³ because it is funded directly through the ACA. Consequently, the future of this system remains uncertain despite progress through increasing documentation during the past 3 years. 

Of the 22,058 practicing cardiologists, 12,078 received some type of payment from medical industries in 2015. Of the $7.52 billion documented in Open Payments for 2015, less than 1% of the total was linked directly to these physicians. Thus, cardiologists received a small proportion of total payments from medical industries to all physicians in 2015. Nevertheless, all physicians should be aware of their data in Open Payments and should regularly monitor their financial relationships with medical industries. Overall, more user input and data collection from Open Payments are needed for further clarification of financial relationships between providers and medical industries. 

All authors provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; all authors drafted the article or revised it critically for important intellectual content; all authors gave final approval of the version of the article to be published; and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.