What Open Payments does not tell you
The five things people routinely misread in doctor payment data, and what each figure actually measures.
A total is not a salary
Open Payments covers three separate programs, and they are different kinds of fact. General payments include meals, travel, consulting fees, speaking fees, gifts and royalties. Research payments are tied to a study and frequently pass through the named physician to a hospital or research institution — the physician often never personally receives the money. Ownership interests are a stake held by the physician or a family member.
Summing all three into one number produces something that describes nothing. That is why this site never does, and why every total on the site arrives with its composition beside it.
Most payments are lunch
Roughly six in ten reported records nationally are food and beverage, and the typical one is worth less than twenty dollars — a sandwich at a lunchtime product presentation in a clinic break room. A physician with two hundred reported payments has usually eaten two hundred modest meals, not received two hundred cheques.
This is why transaction counts and per-transaction averages matter more than headline totals, and why both appear on every profile and company page here.
The largest payments are usually royalties
The physicians at the very top of any Open Payments ranking are, overwhelmingly, people who invented a medical device and receive royalties on it. An orthopaedic surgeon who designed a widely used knee implant is paid for that invention in the same way any inventor would be.
It is disclosed, it is legal, and it is often the reason the device exists. A high rank is a fact about a licensing arrangement, not an allegation.
Medicare figures are a slice, not a practice
No. The Medicare data here is Original Medicare Part B fee-for-service only. It excludes Medicare Advantage — which now covers more than half of all Medicare enrollees — along with Medicaid and every commercial insurance plan. A physician whose patients are mostly on Medicare Advantage can look almost absent from this data while running a busy practice.
It is also gross, not net: the allowed amount pays staff wages, rent, supplies, equipment and malpractice premiums before anything reaches the physician. And CMS suppresses any figure covering ten or fewer beneficiaries, so low-volume providers are systematically understated.
Prescribing cost is money paid to pharmacies
No. The Part D figure is what Medicare drug plans and their beneficiaries paid pharmacies to fill the prescriptions a provider wrote. The prescriber receives none of it. It measures prescribing volume and drug prices — a physician who treats many patients with an expensive drug will show a large number regardless of anything else.
Putting a prescribing total next to a payment total is informative, but only with a peer comparison attached. An endocrinologist who receives meals from a diabetes drugmaker and prescribes a lot of diabetes drugs is doing exactly what an endocrinologist does.