Abstract
ObjectivesTo compare changes in the number and amount of payments received by orthopedic and non-orthopedic surgeons from industry between 2014 and 2017.MethodsUsing the Centers for Medicare and Medicaid Services (CMS) Open Payment database from 2014 to 2017, we conducted a retrospective cohort study of industry payments to surgeons, including general payments and research payments.ResultsAmong orthopedic surgeons, the total number of general payments decreased from 248,698 in 2014 to 241,966 in 2017, but their total value increased from $97.1 million in 2014 to $110.2 million in 2017. Among non-orthopedic surgeons, the total number decreased from 604,884 in 2014 to 582,490 in 2017, while the total value remained stable at approximately $159 million. Between 2014 and 2017, there was a differential increase in the median number of general payments received by non-orthopedic when compared to orthopedic surgeons (incidence rate ratio, 1.09; 95% CI, 1.08–1.09; p < 0.001), but a differential decline in the median value of general payments (− 8.9%; 95% CI, − 9.5%, − 8.4%; p < 0.001). Findings were consistent when stratified by nature of payment. In contrast, between 2014 and 2017, there was neither a differential change in the median number nor median value of research payments received by non-orthopedics.ConclusionExamination of a natural experiment of prior public disclosure of payments to orthopedic surgeons suggests that the Physician Payment Sunshine Act was associated with an increase in the number, but a decline in the value, of general payments received by non-orthopedic surgeons, but not on research payments received.
Highlights
Interactions between physicians and teaching hospitals and the pharmaceutical and medical device industries can benefit patients when they are primarily related to bona fide basic and clinical research to improve patient care
Taking advantage of a natural experiment mandating public disclosure of payments to orthopedic surgeons made by hip and knee surgical implant manufacturers, required as part of 2007 Department of Justice settlement, we tested the impact of the Physician Payment Sunshine Act on the number and value of payments received by physicians from industry
Our findings suggest that mandatory public disclosure of payments from industry was associated with increases in the number of general payments received, predominantly in the form of food and beverages, but with decreases in the median value of the general payments received
Summary
Interactions between physicians and teaching hospitals and the pharmaceutical and medical device industries can benefit patients when they are primarily related to bona fide basic and clinical research to improve patient care. Similar survey studies demonstrated that relationships between industry and academic institutions, including Chairs, Departments, and Institutional Review Boards, were widespread [3, 4] The pervasiveness of these relationships between industry and the medical profession, and the potential for undue influence, were the subject of several articles, conferences, and books, including by preeminent editors of the most prestigious biomedical journals [5,6,7]. These concerns were best summarized in a 2009 report by the Institute of Medicine, which concluded that the primary goals of medicine, defined as improving health by providing beneficial care to patients, conducting valid research, and offering excellent medical education, are at risk of being compromised by the undue pursuit of financial gain or other secondary interests posed by conflicts of interest [8]
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