Mean Payment Research Articles

233.9: The Sun Is Still Shining: Nature of Industry Payments to Transplant Surgeons From 2014-2019

Introduction: This study aims to characterize the nature of these payments made to transplant surgeons over the past six years of Open Payments Program (OPP) data, to better understand the nature of physician-industry relationships within transplant surgery. Methods: The study sample included all physicians (categorized under Urology, Surgery, Pediatric Urology, and Pediatric Surgery) who received at least one non-research payment as transplant surgeons to the OPP. To capture transplant surgeons who may be listed under their pipeline specialty, the American Society of Transplant Surgeons member directory as of January 2021 was queried. Physicians identified as residents in the ASTS member directory were excluded from analysis. Data was analyzed between 2014 and 2019. Results: Total number of transplant surgeons receiving payment 1335. Total amount in dollars paid, $15,661,536. The mean payment was $416.58 (SD $1684.60) and the median payment was $50.00 (IQR $17.44-$151.0). The top three categories include $3,910,288 (26.2%) paid for consulting fees, $4,668,147 (31.3%) paid for non-consulting fees (speaker and vendor fees), and $3,035,045 (20.3%) paid for travel and lodging. OPTN Region 5 received the most payment at 19.3%, and Region 1 received the least payment at 1.5%. The top five companies making payments include Intuitive Surgical Inc, Gilead, Norvartis, Astellas, Genzyme. Conclusions: There is a considerable financial relationship between medical device and pharmaceutical manufacturers and transplant surgeons. The majority of non-research payments to transplant surgeons by industry sponsors were for non-consulting services. There exist regional differences in the amount paid by industry to transplant surgeons in regards to median and total industry payment amounts.

Association Between Care Fragmentation and Total Spending After Durable Left Ventricular Device Implant: A Mediation Analysis of Health Care-Associated Infections Within a National Medicare-Society of Thoracic Surgeons Intermacs Linked Dataset.

Care fragmentation is associated with higher rates of infection after durable left ventricular assist device (LVAD) implant. Less is known about the relationship between care fragmentation and total spending, and whether this relationship is mediated by infections. Total payments were captured from admission to 180 days post-discharge. Drawing on network theory, a measure of care fragmentation was developed based on the number of shared patients among providers (ie, anesthesiologists, cardiac surgeons, cardiologists, critical care specialists, nurse practitioners, physician assistants) caring for 4,987 Medicare beneficiaries undergoing LVAD implantation between July 2009 - April 2017. Care fragmentation was measured using average path length, which describes how efficiently information flows among network members; longer path length indicates greater fragmentation. Terciles based on the level of care fragmentation and multivariable regression were used to analyze the relationship between care fragmentation and LVAD payments and mediation analysis was used to evaluate the role of post-implant infections. The patient cohort was 81% male, 73% white, 11% Intermacs Profile 1 with mean (SD) age of 63.1 years (11.1). The mean (SD) level of care fragmentation in provider networks was 1.7 (0.2) and mean (SD) payment from admission to 180 days post-discharge was $246,905 ($109,872). Mean (SD) total payments at the lower, middle, and upper terciles of care fragmentation were $250,135 ($111,924), $243,288 ($109,376), and $247,290 ($108,241), respectively. In mediation analysis, the indirect effect of care fragmentation on total payments, through infections, was positive and statistically significant (β=16032.5, p=0.008). Greater care fragmentation in the delivery of care surrounding durable LVAD implantation is associated with a higher incidence of infections, and consequently, higher payments for Medicare beneficiaries. Interventions to reduce care fragmentation may reduce the incidence of infections and in turn enhance the value of care for patients undergoing durable LVAD implantation.

Assessment of Determinants of Value in Carotid Endarterectomy

Over 150,000 carotid endarterectomies (CEA) are performed annually worldwide, accounting for $900 million in the United States alone. How cost/spending and quality are related is not well understood but remain essential components in maximizing value. We sought to identify determinants of variability in hospital 90-day episode value for CEA. Medicare and private-payer admissions for CEA from January 2, 2014 to August 28, 2020 were linked to retrospective clinical registry data for hospitals in Michigan performing vascular surgery. Hospital-specific, risk-adjusted, 30-day composite complications (defined as reoperation, new neurologic deficit, myocardial infarction, additional procedure including CEA or carotid artery stenting, readmission, or mortality) and 30-day risk-adjusted, price-standardized total episode payments were used to categorize hospitals into low or high value by defining the intersection between complications and spending. A total of 6,595 patients across 39 hospitals were identified across both datasets. Patients at low-value hospitals had a higher rate of 30-day composite complications (17.9% vs. 10.1%, P<0.001) driven by a significantly higher rate of reoperation (3.0% vs. 1.4%, P=0.016), readmission (10.7% vs. 6.2%, P=0.012), new neurologic deficit (4.6% vs. 2.3%, P=0.017), and mortality (1.6% vs. 0.6%, P<0.049). Mean total episode payments were $19,635 at low-value hospitals compared to $15,709 at high-value hospitals driven by index hospitalization ($10,800 vs. $9,587, P=0.002), professional ($3,421 vs. $2,827, P<0.001), readmission ($3,011 vs. $1,826, P<0.001), and post-acute care payments ($2,335 vs. $1,486, P<0.001). Findings were similar when only including patients who did not suffer a complication. There is tremendous variation in both quality and payments across hospitals included for CEA. Importantly, costs were higher at low-value hospitals independent of postoperative complication. There appears to be little to no relationship between total episode spending and surgical quality, suggesting that improvements in value may be possible by decreasing total episode cost without affecting surgical outcomes.

A Comprehensive Analysis of the Costs of Severe Maternal Morbidity.

The objectives of this study were to include readmissions and physician costs in the estimates of total costs of severe maternal morbidity (SMM), to consider the effect of SMM on maternal length of stay (LOS), and to examine these for the more restricted definition of SMM that excludes transfusion-only cases. California linked birth certificate-patient discharge data for 2009 through 2011 (n=1,262,862) with complete costs and LOS were used in a secondary data analysis. Cost-to-charge ratios were used to estimate costs from charges, adjusting for inflation. Physician payments were estimated from the mean payments for specific diagnosis-related groups. Generalized linear models estimated the association between SMM and costs and LOS. Excluding readmissions and physician costs, SMM was associated with a 60% increase in hospital costs (marginal effect [ME] $3,550) and a 33% increase in LOS (ME 0.9days). These increased to 70% (ME $5,806) and 46% (ME 1.3days) when physician costs and readmissions were included. The effects of SMM were roughly one-half as large for patients who only required a blood transfusion (49% [ME $4,056] and 31% [ME 0.9days]) as for patients who had another indicator for SMM (93% [ME $7,664] and 62% [ME 1.7days]). Postpartum hospital readmissions and physician costs are important and previously unreported contributors to the costs of SMM. Excess costs and LOS associated with SMM vary considerably by indication. Cost effects were larger than the LOS effects, indicating that SMM increases treatment intensity beyond increasing LOS, and decreasing SMM may have broader health and cost benefits than previously understood.

Association of Children’s Hospital Status With Value for Common Surgical Conditions

Although children's hospitals (CH) provide a substantial proportion of highly specialized pediatric care in the United States, the value of CH compared with non-children's hospitals (NCH) for routine surgical procedures is unknown. To examine the value of CH for routine surgical procedures by assessing clinical outcomes and payment data. This retrospective cohort study examined pediatric patients undergoing 1 of 13 commonly performed surgical procedures between 2010 and 2015 with 90-day follow-up using administrative data from the Health Care Cost Institute. Data analysis was conducted from July 2019 to December 2021. The primary exposure was tier of CH status, defined using self-reported pediatric services, affiliation with pediatric focused programs, and validated based on proportion of pediatric admissions. Payments for common surgical procedures from private insurers and overall complication and readmission rates at 30, 60, and 90 days. There were 368 220 pediatric patients who underwent one of the surgical procedures of interest; 220 899 (60.0%) of the patients were male; 118 977 (32.3%) had their procedure at freestanding CH (CH-A), 75 256 (20.4%) at CH attached to an adult hospital (CH-B), and 173 987 (47.3%) at NCH. The mean (SD) payment for all procedures at CH-A was $6533.56 ($6399.97), $5847.50 ($4947.47) at CH-B, and $5034.25 ($4787.07) at NCH. The mean (SD) overall complication rate was 0.004 (0.06) at CH-A, 0.01 (0.07) at CH-B, and 0.003 (0.06) at NCH. Readmission rates at 30, 60, and 90 days were similar across all hospital types. After adjusting for zip code, year, surgery, surgery setting, and observable patient, hospital, and county characteristics, the estimated payments for inpatient common procedures were 39% higher at CH-A than at NCH. Payments for outpatient common procedures were 34% higher at CH-A than at NCH. In this cohort study, children who underwent common surgical procedures had equivalent clinical outcomes at CH and NCH but the procedures were associated with higher payments and, thus, overall lower value care. To ensure delivery of optimal value to patients and payers, more research is needed to evaluate mechanisms to ensure access, decrease costs, and improve value at both CH and NCH.

Pharmaceutical industry payments to physicians for the promotion of cancer drugs.

1580 Background: Personal financial payments from the pharmaceutical industry to oncologists are common and increasing. A prevalent view is that the purpose of industry payments to physicians is to facilitate education on new drugs. However, little is known regarding the distribution and trends in industry payments related to cancer drugs. The goal of this study was to characterize current patterns in industry payments related to cancer drugs, and test whether these patterns are consistent with an educational purpose. Methods: We included on-patent cancer drugs without generic/biosimilar competitors, and used publicly-available federal data sources to measure Medicare spending (proxy for overall drug revenue), number of prescribers, and industry payments (Open Payments, which includes data regarding which the drug[s] was the subject of each payment) for each calendar year from 2014-2018. We analyzed General Payments to individual physicians, which encompasses payment types such as meals, travel, consulting, and speaking fees. We tested two hypotheses implied by the claim that industry payments serve educational purposes. First, payment amounts should not be associated with drug revenue. To test this hypothesis, we used generalized estimating equations (GEE) to model the association between mean per-physician industry payments and Medicare spending. Second, payments related to a given drug should decline over time as physicians become educated. To test this hypothesis, we determined the relative year-to-year change in industry payments for all cases wherein consecutive years were observed, and used GEE to estimate the year-to-year change with respect to duration of time since initial FDA approval. Results: The sample included 89 drugs and 361 drug-year observations. The total amount of industry payments for oncology drugs increased during the study period, from $53,333,854 in 2014 to $90,343,731 in 2018. There was no association between log-transformed mean, per-physician industry payments and per-physician Medicare spending (estimate -0.001, 95%CI: -0.005, 0.004). In aggregate, Industry payments for cancer drugs were greatest immediately after FDA approval and trended downward over time; the estimated industry payments in the subsequent year for a drug with mean payments of $1,000 per-physician in the index year was: $681* for drugs 0-4 years since approval, $825 for drugs 5-9 years, and $679* for drugs≥10 years (*p&lt;0.05). Conclusions: The absence of association between industry payments and Medicare spending and the decline in industry payments for drug subsequent to approval are consistent with claims that these payments function to facilitate physician education.

The Sun Is Still Shining: Nature of Industry Payments to Transplant Surgeons From 2014 to 2019.

Background.Established in 2013, the Open Payments Program (OPP) mandated that medical device and pharmaceutical manufacturers submit record of any financial incentive given to physicians to the Centers for Medicare and Medicaid Services, which is in turn made publicly available. This study aims to characterize these payments to transplant surgeons over the first 6 y of OPP data.Methods.The study sample included all physicians who received at least one nonresearch payment as transplant surgeons to the OPP. To capture transplant surgeons who may be listed under their pipeline specialty, the American Society of Transplant Surgeons member directory as of January 2021 was queried. Payments were analyzed temporally, geographically, and by payment type, physician, and industry payer.Results.In total, payments totaling $15 661 536 were made to 1335 transplant surgeons over the study period. The mean payment was $436.90 (SD, $1760), and the median payment was $52.94 (interquartile range, $18.29–$159.80). The top contributing companies were Intuitive Surgical, Inc.; Gilead Sciences, Inc.; and Novartis Pharmaceuticals. Only 5.3% ($827 236) was paid toward faculty or as a speaker for a nonaccredited and noncertified continuing education program and honorarium. Educational payments came in at $1 233 141 (7.9%) over the study period. $13 750 828.60 (87.8%) of the payments were for other categories (consulting fees, food and beverages, etc). Organ transplant and procurement region 7 and 8 transplant surgeons received the highest median payments during the study period.Conclusions.This study is the first to characterize the payments made to transplant surgeons since the passage of the Sunshine Act. Further studies are needed to understand and interpret the relationship between industry and transplant surgeons, as the payments may or may not translate to influence in medical decisions or use of medical devices.

Implications of Payment for Acute Myocardial Infarctions as a 90-Day Bundled Single Episode of Care: A Cost of Illness Analysis.

ObjectivesEvaluate the cost of illness associated with the 90-day period following acute myocardial infarction (AMI) and the implication of care pathway (percutaneous coronary intervention [PCI] vs medical management [MM]), in order to assess the potential financial risk incurred by providers for AMI as an episode of care.PerspectiveReimbursement payment systems for acute care episodes are shifting from 30-day to 90-day bundled payment models. Since follow-up care and readmissions beyond the early days/weeks post-AMI are common, financial risk may be transferred to providers.SettingAMI hospitalization Centers for Medicare & Medicaid Services (CMS) standard analytical files between 10/1/2015 and 9/30/2016 were reviewed.MethodsIncluded patients were Medicare beneficiaries with a primary diagnosis of AMI subsequently treated with either PCI or MM. Payments were standardized to remove geographic variation and separated into reimbursements for services during the hospitalization and from discharge to 90 days post-discharge. Results were stratified by Medicare Severity Diagnosis Related Groups (MS-DRGs) individually and grouped between patients treated with MM and PCI. Risk-adjusted likelihood of utilization of post-acute nursing care and all-cause readmission was assessed by logistic regression.ResultsA total of 96,546 patients were included in the analysis. The highest total mean payment (US$32,714) was for MS-DRG 248 (PCI with non-drug-eluting stent with major complication or comorbidity). Total payments were similar between MM and PCI patients, but MM patients incurred the majority of costs in the post-acute period after discharge, with the converse true for PCI patients. MM without catheterization was associated with a twofold increase in risk of requiring post-acute nursing care and 90-day readmission versus PCI (odds ratio [95% confidence interval]: 2.01 [1.92–2.11] and 2.17 [2.08–2.27]). Smaller hospital size, diabetes, peripheral arterial disease, prior AMI, and multivessel disease were predictors of higher healthcare utilization.ConclusionsMS-DRGs associated with the lowest reimbursements (and presumably, lowest costs of inpatient care) incur the highest post-discharge expenditures. As the CMS Bundled Payment for Care Improvement and similar programs are implemented, there will be a need to account for heterogeneous post-discharge care costs. Video abstract (MP4 274659 KB)Supplementary InformationThe online version contains supplementary material available at 10.1007/s41669-022-00328-4.

Abstract WMP50: Saving Lives And Saving Money With Tele-stroke: Population Health Economics In South Carolina

Background: Over the past decade, tele-stroke networks have been shown to remarkably improve our ability to provide timely treatments for stroke patients. Data on the economic impact of tele-stroke networks are scarce. Our aim is to assess the economic impact associated with the adoption of tele-stroke in local, geographically defined areas in the state of South Carolina (SC). Methods: Data were extracted from SC All-payer hospital discharges database from 2014-1017. Patients included were admitted with primary diagnosis ICD-9 codes for acute ischemic stroke. SC tele-stroke tracking data was used to assign county exposure. Data was analyzed using multivariable logistic, Poisson and gamma regression models with robust error variance in Proc Genmod to estimate effects. Multiple variables were assessed including tPA treatment, mechanical thrombectomy, and cost of in-hospital and follow up care for readmissions or ED visits in patients that had tele-stroke available in-county compared to those that did not. Results: A total of 33,603 patients were included in these analyses. A total of 2,799 patients received tPA and 695 patients received mechanical thrombectomy. Estimated mean hospital payments were $13,715 (SD $15,742) for patients with tele-stroke available compared to $14,065 (SD $15,477) where tele-stroke was not available (P=0.0002). Total mean payments were significantly higher for patients without tele-stroke availability ($34,560 SD $51,049) compared to patients with tele-stroke available ($31,744, SD $45,517) (P&lt;0.0001). Mean total follow up payments were also calculated and found to be significantly different for patients with tele-stroke available ($30,451, SD $50,367) compared to patients without tele-stroke ($34,258, SD $57,921) (P&lt;0.0001). Conclusion: Our results indicate that tele-stroke presence in geographic locations improves treatment and outcomes in patients with acute ischemic stroke and may be expected to have an economic benefit. We observed a significant population-level association between availability of tele-stroke and mean hospital payments, follow up payments, and follow up ER visit payments.

CMS Open Payments Database Analysis of Industry Payments for Foot and Ankle Surgery Research

With decreasing federal funding, the role of industry in supporting medical investigations continues to grow. To increase transparency between physicians and industry, the Centers for Medicare and Medicaid Services introduced the Open Payments Program, providing a searchable database of physician payments from entities including medical device companies. This study describes industry research payments and trends among foot and ankle surgeons. Research Payment Data among foot and ankle surgeons from the Open Payments Database was reviewed from 2013 through 2020. Payment year, value, type, and physician name were collected, and descriptive statistics were presented. Linear regression assessed trends in the number and value of payments. Analysis of variance and subsequent post hoc testing assessed differences in mean payment value. A p value of ≤.05 was considered statistically significant. Overall, 10,872 payments totaling $69,595,393.10 among 446 foot and ankle surgeons were analyzed. No statistically significant increase in number of physicians, payments, or mean payment value per physician was observed from 2013 through 2020. However, the average value of payments in 2019 and 2020 was greater than 2015 and 2017 (p ≤ .05). The top 50 physicians according to cumulative payment value received $54,696,623.10 with 9427 (86.7%) cash and cash-equivalent payments representing the most common payment type overall. Industry continues to provide financial support to foot and ankle surgery research. Results of this investigation spur future studies to examine the relationship between payments and positive results reported by lead investigators in published research.

Increasing Financial Payments From Industry to Medical Oncologists in the United States, 2014-2017.

Personal payments from the pharmaceutical industry to US physicians are common and are associated with changes in physicians' clinical practice and interpretation of clinical trial results. We assessed temporal trends in industry payments to oncologists, with particular emphasis on payments to authors of oncology clinical practice guideline and on payments related to immunotherapy drugs. We included US physicians with active National Plan and Provider Enumeration System records and demographic data available in the Centers for Medicare & Medicaid Services Physician Compare system who had a specialty type of medical oncology or general internal medicine. Medical oncologists serving on NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Panels were identified manually. Industry payments, and the subset associated with PD-1/PD-L1 drugs, were identified in Open Payments, the federal repository of all transactions of financial value from industry to physicians and teaching hospitals, from 2014 to 2017. There were 13,087 medical oncologists and 85,640 internists who received payments. The mean, annual, per-physician value of payments to oncologists increased from $3,811 in 2014 to $5,854 in 2017, and from $444 to $450 for internists; the median payment increased from $152 to $199 for oncologists and remained at $0 for internists. Oncologists who served on NCCN Guidelines Panels received a greater value in payments and experienced a greater relative increase: mean payments increased from $10,820 in 2014 to $18,977 in 2017, and median payments increased from $500 to $1,366. Among companies marketing PD-1/PD-L1 drugs, mean annual per-oncologist payments associated with PD-1/PD-L1 drugs increased from $28 to $773. Total per-oncologist payments from companies marketing PD-1/PD-L1 drugs experienced a 165% increase from 2014 to 2017, compared with a 31% increase among similar companies not marketing PD-1/PD-L1 drugs. Pharmaceutical industry payments increased for US oncologists from 2014 to 2017 more than for general internists. The increase was greater among oncologists contributing to clinical practice guidelines and among pharmaceutical companies marketing PD-1/PD-L1 drugs. The increasing flow of money from industry to US oncologists supports ongoing concern regarding commercial interests in guideline development and clinical decision-making.

Physician Reimbursement for Endoscopic Submucosal Dissection: A Single Center Analysis

Background and AimsEndoscopic Submucosal Dissection (ESD) has become an established procedure for resection of pre-malignant lesions. Despite its benefits and cost-effectiveness, there are significant challenges to bring ESD to mainstream practice given the unpredictability of reimbursement. ESD is submitted for billing purposes without dedicated Current procedural terminology codes. We analyzed physician component billing and reimbursement data indexed to time, procedure location, and insurance type. MethodsAll physician billing claims and reimbursement data for ESD cases performed between January 2017 and December 2019 in a single tertiary referral center were included. Procedure type was grouped by lesion location: esophageal ESD, gastric and/or duodenal ESD, and colon and/or rectal ESD. To normalize the data, we divided the total dollar payment by the number of hours it took to complete the procedure. ResultsCompleted insurance claims were available for 163 procedures, and 134 met criteria for this study. In our analysis there were 42 government, 92 private insurance payers. The mean charge was $3562.31 for government claims and $3471.33 for private claims. The mean payment was $905.01 (range: $55.64-6140) for government payers, and $1134.24 (range: $44.26-3500) for private payers. The average payment per procedure was $886.43 for esophageal ESD, $732.71 for gastric or duodenal ESD and $1325.35 for colon and/or rectal ESD. The mean $ amount for claims paid for all endoscopic mucosal resection performed in the same time period was $405.50 (range: $106-$1775). ConclusionESD is consistently under-reimbursed across insurance types when compared to surgical alternatives and endoscopist time. With proven efficacy, safety and cost-saving data, appropriate Current procedural terminology codes should be provided for ESD.

Current Healthcare Utilization and Alternative Strategies for Rotator Cuff Tendinopathy (239)

Objectives:Rotator cuff disease is one of the most common reasons for people to seek upper extremity specialty care. Rotator cuff tendinopathy is typically a part of the normal aging process and is often well adapted. Healthcare utilization for the condition varies widely and can range from formal physical therapy to surgery. Evidence of the effectiveness of some interventions for rotator cuff tendinopathy is lacking and for others, such as steroid injection or subacromial decompression, suggests no benefit. There is an opportunity to streamline care for this common condition and, in doing so, conserve finite healthcare resources. The purpose of this study was to characterize the current healthcare utilization for rotator cuff tendinopathy using a large claims database in an effort to identify opportunities to streamline care and develop value-based treatment algorithms.Methods:Using de-identified records in a large claims data base that includes over 350 private-sector payers, we identified patients with a new visit claim between April and June 2016 in one state with an ICD-10 diagnosis code for rotator cuff tendinopathy. The most common atraumatic diagnoses and the frequency of interventions, such as surgery, physical or occupational therapy, advanced imaging, and injections were tracked. We recorded all return visits (including post-operative visits), tests, treatments, and costs for 3 months prior and 6 months after diagnosis. We then calculated the potential cost savings using an alternative treatment strategy for rotator cuff tendinopathy based on value-based care principals.Results:The percentage of enrollees undergoing specific interventions was MRI 19%; physical therapy visit 29%; injections 52%; return visits 44%; and surgery 17%. Alternative treatment strategies, such as a reliance on home exercises rather than formal physical therapy, avoidance of injections and limiting MRIs to patients considering surgery accounted for a potential mean payment that was 8% of the actual mean payments of claims paid out in the database.Conclusions:Conclusion: Our analysis identified notable variation in care of people with rotator cuff tendinopathy. Alternative treatment strategies identified an opportunity for improving value given growing evidence that limiting some of the more commonly used interventions is unlikely to diminish health and might even improve it by increasing self-efficacy.

Disparities Among Industry's Highly Compensated Orthopaedic Surgeons.

Background:The prosperous financial relationship between physicians and industry remains a highly scrutinized topic. Recently, a publicly available website was developed in conjunction with the U.S. Affordable Care Act to shed light on payments from industry to physicians with the goal of increasing transparency. The purpose of this study was to assess possible relationships between industry payments and orthopaedic surgeon gender, subspecialty training, and practice settings.Methods:A retrospective analysis was performed using publicly available information from the Centers for Medicare & Medicaid Services (CMS) to identify the 25 orthopaedic surgeons with the highest compensation from each of the 10 largest orthopaedic companies from 2013 to 2017. Statistical analyses were conducted to investigate the factors that contributed to payment differences.Results:Among the 347 highest-compensated orthopaedic surgeons, only 1 woman (0.29%) was identified. Orthopaedic surgeons in the subspecialties of spine (32.9%), adult reconstruction (27.9%), and sports medicine (14.5%) made up a majority of the 25 highest earners. A larger proportion of the physicians in this study worked in private practice (57.6%) compared with an academic setting (42.4%). Orthopaedic surgeons who subspecialize in sports medicine had significantly higher total mean payment amounts when compared with all other specialties. The primary method of compensation was found to be through licensing or royalty payments.Conclusions:The large majority of orthopaedic surgeons who are highly compensated from industry are men. Among these, the greatest number specialize in the spine, while sports medicine surgeons receive significantly higher total mean payment amounts. Additional studies are warranted to evaluate the disparities between men and women and encourage policies to promote gender equality.

Conflict of Interest at Microsurgery Conferences: Disclosure of Its Extent and Nature

Industry relationships and conflicts of interest can impact research funding, topics, and outcomes. Little research regarding the role of biomedical companies at microsurgery conferences is available. This study evaluates the role of industry at conferences by comparing payments received by speakers at the American Society for Reconstructive Microsurgeons (ASRM) meeting with those received by speakers at the American Society of Aesthetic Plastic Surgeons (ASAPS) meeting, the American Society of Plastic Surgeons (ASPS) meeting, and an average plastic surgeon. It also compares payments made by different companies. General payments received by speakers at the 2017 ASAPS, ASPS, and ASRM conferences were collected from the Open Payments Database. Mean payments received at each conference were calculated and the Mann-Whitney U test evaluated differences between conference speakers and the average plastic surgeon. The total amount of payments from each company was collected through the Open Payments Database, and Z-tests identified which companies paid significantly more than others. The mean (and median) general payments made to conference speakers at ASAPS (n = 75), ASPS (n = 247), and ASRM (n = 121) were $75,577 ($861), $27,562 ($1,021), and $16,725 ($652), respectively. These payments were significantly greater (p < 0.001 for all) than those of the average plastic surgeon ($4,441 and $327), but not significantly different from each other. Allergan contributed significantly more than other companies to speakers at ASPS and ASAPS, while LifeCell Corporation, Zimmer Biomet Holdings, and Axogen contributed significantly more to speakers at ASRM. Payments to physicians at ASRM were significantly higher than those of an average plastic surgeon but not significantly different from those of speakers at ASAPS and ASPS. Certain companies paid significantly more than their peers at each conference. Given these findings, speakers should strive to make clear the nature and extent of their conflicts of interest when presenting at conferences.

Analysis of Costs and Payments for Inferior Vena Cava Filter Retrieval in the Medicare Population

Over the past decade, inferior vena cava (IVC) filter retrieval has been increasing, in part due to Food and Drug Administration recommendations and legal pressure. The costs and margin of IVC filter removal are poorly understood. Medicare claims data from 2016 for the 103 highest volume centers for IVC filter retrieval were examined. Pooled mean charges, costs, payments, and margin were calculated by institution. Mean ± SD charges, costs, and payments were $14,138.00 ± $8,400.48, $3,693.28 ± $2,294.27, and $1,949.82 ± $702.91, respectively. Average (range) margin was −$1,706.18 (−$7,509.93 to $362.77). The margin was negative in 99 of the 103 (96%) institutions evaluated. The most significant contributors to the total procedure cost were operating room, supplies, and recovery (44.5%, 23.5%, and 10.4%, respectively). While IVC filter retrieval is often medically indicated, it is typically associated with a financial loss under current reimbursement structure.

Robotic hysterectomy compared with laparoscopic hysterectomy: is it still more costly to perform?

To establish the economic value of simple robotic hysterectomy vs laparoscopic hysterectomy and assess the impact of surgeon's experience. Retrospective cohort study. University-affiliated US regional healthcare system. Reproductive and post-menopausal women undergoing hysterectomy for benign indications. Robotic or laparoscopic hysterectomy. Between January 2018 and December 2019, a total of 985 simple laparoscopic and robotic hysterectomies were performed by 47 different gynecologists. Overall, the mean payment, direct cost, and profit were comparable (p value > 0.05) among simple robotic and laparoscopic hysterectomy. However, the mean operative time was significantly shorter for robotic hysterectomy compared to laparoscopic hysterectomy (106min vs 127min, respectively, p < 0.05). Operative time decreased as a surgeon's annual robotic case volume increased. Per-minute profitability of robotic hysterectomy increased significantly when a surgeon performed greater than 45 cases annually (p = 0.04). This effect became most pronounced when a surgeon performed 60 or more cases per year (p = 0.01). Simple robotic hysterectomy has shorter operative time compared to laparoscopic hysterectomy, with direct costs being similar. Robotic hysterectomy has higher per-minute profit compared to laparoscopic hysterectomy when a surgeon performs > 45 cases per year.

Physicians payment in the United States between 2014 and 2018: An analysis of the CMS Open Payments database.

The Open Payments database reports payments made to physicians by industry. Given the potential for financial conflicts of interest relating to patient outcomes, further scrutiny of these data is valuable. Therefore, the objective of this study was to analyze physician-industry relationships by specialty type, payment type, geospatial trend, and longitudinal trend between 2014–2018. We conducted an observational, retrospective data analysis of payments from the Open Payments database for licensed United States physicians listed in the National Plan & Provider Enumeration System (NPPES). Datasets from 2013–2018 were joined using the Python programming language. Aggregation and sub-setting by characteristics of interest was done in R to calculate means and frequencies of reported general physician payments from industry across different specialties, locations, timeframes, and payment types. Normalization was applied for numbers of physicians or payments. Geospatial statistical hot spot analysis was conducted in ArcGIS. 51.73 million payment records were analyzed. In total, 50,047,930 payments were issued to 771,113 allopathic or osteopathic physicians, representing $8,702,631,264 transferred from industry to physicians over the five-year period between 2014 and 2018. The mean payment amount was $179, with a standard deviation of $12,685. Variability in physicians’ financial relationships with industry were apparent across specialties, regions, time, and payment type. A limited match rate between records in the NPPES and Open Payments databases may have resulted in selection bias of trends related to physician characteristics. Further research is necessary, particularly in the context of changing industry payment trends and public perceptions of the appropriateness of these relationships.

124 Financial strain caused by COVID-19 and its impact on equine industry participant willingness-to-pay for equine care

The novel COVID-19 virus caused a global pandemic disrupting lives, industries, and economies. The resulting financial strain impacted prices due to challenges with production and supply chain distribution. This study investigates the financial strain COVID-19 had on equine owners and leasers, what the market for equine care would bear if costs for care were to increase, and what factors contribute to willingness-to-pay (WTP) for increasing cost of equine care. An online survey was distributed for 4 weeks to adult US residents, where respondents reported their involvement in the equine industry, financial response to COVID-19, and responses to a double-bound dichotomous choice question pertaining to their WTP for care given a randomized increase (1–20%) in their current cost (n = 506). Data were analyzed using interval regression models where a = 0.05 (Stata15). Respondents were separated into 3 groups (owner keeping their horse at their residence, owner boarding their equids, and leaser) based on their equine ownership status and where their equine were kept. Boarders reported mean monthly payments of 23.33 ± 90.37 USD (n = 15) for free board, 236.47 ± 151.92 USD, (n = 75) for partial board, and 514.75 ± 291.71 USD (n = 181) for full board. Results show all owners, leaser, and boarders have different WTP values which range from 18.5% to 26.2% increase in current care costs which extends beyond the presented range due to many respondents responding “yes” to both WTP questions (71% of owners, 6% of boarders, 65% of leasers) and the use of mean values across the entire sample in predicting the WTP. Equine owners, with on farm equids from the southern US were WTP 11% less than from other regions ( P = 0.015). The current boarding fees from owners that board their equids lowered their WTP by 0.01% ( P = 0.029) for each additional dollar paid, whereas current care costs were not a significant factor for other owners ( P = 0.370) or leasers ( P = 0.395). Those that had a full lease for their equids, whether housed on farm or at a facility, were WTP 15% higher ( P = 0.036) than those that had a partial or no lease. In comparison, boarding status (full, partial, or no boarding) did not significantly ( P = 0.51) impact boarder's WTP. Age of respondent and annual household income heterogeneously affected WTP across all groups. These results indicate the market for equine care can bear the increases in cost associated with financial distress related to COVID-19. Results from this study should be taken in context of the global pandemic and the restrictions in place, or lack thereof, at the time the survey was administered.

Abstract No. 515 Five-year nationwide analysis and trends of industry payments to interventional radiologists

To characterize trends in industry payments to interventional radiologists since the implementation of the Physician Payments Sunshine Act Industry payments to all physicians classified as vascular and interventional radiologists reported in the first five fully reported years (2014–2019) in the Centers for Medicare and Medicaid Services’ Open Payments Program in the United States were analyzed. The total number of annual payments categorized into reason for payment were aggregated in total and relative terms and analyzed. Mean and median payment amounts per transaction were also calculated. A total of 2958 individual interventional radiologists received at least one payment during the 5-year study period. A majority (1670, 56.4%) received at least one payment every year during the study period. The number of individuals receiving payments of any form increased by 27% from 1670 in 2014 to 2292 in 2019. A total of 244 entities distributed payments at least one year during the study period with a majority (209, 85.7%) contributing every year. The total monetary value of payments decreased with means of $26,738,248 and $12,053,275 distributed in 2014 to 2015 and 2016 to 2019, respectively. Royalty/license and research payments demonstrated the largest absolute and relative decreases of $6,972,514 (73%) and $2,097,833 (69%), respectively. Payments associated with consulting fees; travel and lodging costs; and entertainment, food and beverage expenditures demonstrated average increases of $634,432 (21%), $401,626 (55%) and $401,626 (22%). The total number of unique payments increased with 18,915 and 25,882 transactions reported during 2014 to 2015 and 2016 to 2019, respectively. There was a corresponding decrease in mean value per payment from $1413.60 to $465.70 in 2014 to 2015 and 2016 to 2019, respectively. The overall and average monetary value of industry payments to interventional radiologists has decreased during the first five fully reported years in the Open Payments Program. However, ties with industry reached a larger cross-section of the interventional community as evidenced by the increasing number of individuals receiving payments. Interventional radiologists need to be aware of publicly available industry-related payment information and their potential for conflicts of interest as perceived by patients.