Internal medicine physicians and orthopedic surgeons received $111 million each from pharmaceutical and medical device companies at the end of 2013, totaling more than $475 million in payments to doctors from the industry during that time, according to a study of the Open Payments database managed by the Centers for Medicare and Medicaid Services.

Researchers from the University of California, San Diego School of Medicine analyzed the database, a mandate of the Affordable Care Act called the Physician Payment Sunshine Act, that requires manufacturers to report payments made to physicians or teaching hospitals, as well as any ownership or investment interests that physicians have in the companies. They compared payments and investment interests among various specialties during the last five months of 2013 and the results were published online this week in the journal Mayo Clinic Proceedings.

“The Sunshine Act, which was passed under the Affordable Care Act, was really transformative in terms of transparency,” the principal investigator, Dr. Jona Hattangadi-Gluth, a radiation oncologist and chief of the central nervous system tumor service at UC San Diego Health, told HCB News.

Pharmaceutical companies and medical device manufacturers must report the payments — which include consulting and speaking fees, meals, travel expenses and research grants — to the database, and the physicians then confirm the information. The researchers separated general and research payments, with 10 percent, or $45 million of the $475 million amount, earmarked for research. The study did not look at payments to institutions.

The biggest payments to doctors, according to the study, were for compensation for services ($113 million, or 24 percent), royalty and license payments ($107 million, or 22 percent) and consulting fees ($94 million, or 20 percent). More than 80 percent of the records were payments for meals.

Cardiovascular and gastroenterology specialists were among those that received the most payments, 78 percent and 68 percent respectively, according to the study. Orthopedic surgery, neurosurgery and neurology had the highest mean value of general payments per physician, and the authors said that this was likely because these doctors generally depend more on expensive devices and equipment for their procedures, and because physicians have become more involved in drug and device development.

“Even though in some specialties the average payment is very high, that seems to be driven by only a few physicians within that specialty,” Hattangadi-Gluth said.

The study also noted that more than 2,000 physicians were reported with investment interests, with $310 million invested and $447 million in total value of interest. Urologists, neurosurgeons and orthopedic surgeons were more likely to have ownership interests, according to the study.

Hattangadi-Gluth said the increase in transparency isn’t necessarily a bad thing for physicians.

“There are some studies that suggest that patients want their physicians more engaged with the companies making the drugs or the devices that are being used on them,” Hattangadi-Gluth said.

However, physicians should be aware of what the database shows, she said. The study authors plan to eventually look at whether the payments from manufacturers have impacted treatment decisions.

“I think it’s really important, now that the payment data is completely transparent, to try to see the context,” Hattangadi-Gluth said. “I think physicians see a value in this, too, because I think it’s important to know how our specialty is portrayed within the context of these data. I think it’s important for us to be aware that our nature of financial interaction is available.”