Medicaid Services Open Payments Research Articles

Editors' note: Financial relationships between neurologists and industry: The 2015 Open Payments database

In “Financial relationships between neurologists and industry: The 2015 Open Payments database,” Drs. Ahlawat and Narayanaswami analyzed payments from the pharmaceutical and device industry to neurologists in 2015 using the Centers for Medicare and Medicaid Services Open Payments database (OP). In response, Dr. Sethi argues that lack of distinction between obvious bias and potential conflicts of interest (COIs) in OP risks eroding trust in physician–patient relationships, and proposes voluntary disclosures of relevant COIs with regulatory oversight as an alternative. In contrast, Drs. Robbins and Meyer view OP as an important step towards transparency by making COIs more widely available, and towards greater divestment from financial COIs through resultant social pressure. They present data suggesting a drop in investments and financial ownership among neurologists in OP from 2013 to 2016. Responding to these comments, Drs. Ahlawat and Narayanaswami note that voluntary disclosure may be limited by failure to recognize COIs and would add to physicians' reporting burden. They acknowledge that OP is a step forward, but note that detailed clarification of the nature of payments would allow full transparency and mitigate misinterpretation. They also note that the effect of social pressure or public access to OP on divestiture would be challenging to assess. In “Financial relationships between neurologists and industry: The 2015 Open Payments database,” Drs. Ahlawat and Narayanaswami analyzed payments from the pharmaceutical and device industry to neurologists in 2015 using the Centers for Medicare and Medicaid Services Open Payments database (OP). In response, Dr. Sethi argues that lack of distinction between obvious bias and potential conflicts of interest (COIs) in OP risks eroding trust in physician–patient relationships, and proposes voluntary disclosures of relevant COIs with regulatory oversight as an alternative.

Evaluation of Sex Distribution of Industry Payments Among Radiation Oncologists

Industry relationships are an important measure of professional advancement; however, the association between physician sex and industry payments in radiation oncology has not been described. To update the trends in the sex distribution of industry payments in radiation oncology. This retrospective cross-sectional study was conducted between July 1, 2018, and August 31, 2018. It used the publicly available Centers for Medicare & Medicaid Services (CMS) Open Payments program and CMS Physician and Other Supplier Public Use File databases to obtain 2016 industry payment data for US radiation oncologists who reported receiving industry funding in that year (n = 3052). Total monetary value, number of payments, and median payment amounts were determined for each sex in the following categories: research, consulting, honoraria, industry grants, royalty or license, and services other than consulting. Industry payment amounts among 3052 radiation oncologists who reported receiving payments in 2016; association of median payment with the types of payment by sex. Of the total 4483 radiation oncologists who practiced in 2016, 1164 (25.9%) were female and 3319 (74.0%) were male. Industry payments were distributed among 3052 radiation oncologists (68.1%), of whom 715 (23.4%) were female and 2337 (76.6%) were male. The proportion of female radiation oncologists who received at least 1 industry payment was 61.4% (715 of 1164), whereas the proportion of their male counterparts was 70.4% (2337 of 3319). Across all payment types, female radiation oncologists received a smaller percentage of total industry funding than the percentage of female physicians represented in each category. The median payment value was smaller for female radiation oncologists in consulting (-$1000; 95% CI, -$1966.67 to $100.63; P = .005) and honoraria (-$500; 95% CI, -$1071.43 to $0; P = .007). This trend was also observed in research payments, but was not statistically significant (-$135.02; 95% CI, -$476.93 to $6.88; P = .08). Of the $1 347 509 royalty or license payments made to 72 physicians, none was for female radiation oncologists. Distribution of industry payments appears to show sex disparity in industry relationships among radiation oncologists; this observation warrants further investigation to determine the underlying reasons and provide avenues for increased parity.

Association of Pharmaceutical Industry Marketing of Opioid Products With Mortality From Opioid-Related Overdoses

ImportancePrescription opioids are involved in 40% of all deaths from opioid overdose in the United States and are commonly the first opioids encountered by individuals with opioid use disorder. It is unclear whether the pharmaceutical industry marketing of opioids to physicians is associated with mortality from overdoses.ObjectiveTo identify the association between direct-to-physician marketing of opioid products by pharmaceutical companies and mortality from prescription opioid overdoses across US counties.Design, Setting, and ParticipantsThis population-based, county-level analysis of industry marketing information used data from the Centers for Medicare & Medicaid Services Open Payments database linked with data from the Centers for Disease Control and Prevention on opioid prescribing and mortality from overdoses. All US counties were included, with data on overdoses from August 1, 2014, to December 31, 2016, linked to marketing data from August 1, 2013, to December 31, 2015, using a 1-year lag. Statistical analyses were conducted between February 1 and June 1, 2018.Main Outcomes and MeasuresCounty-level mortality from prescription opioid overdoses, total cost of marketing of opioid products to physicians, number of marketing interactions, opioid prescribing rates, and sociodemographic factors.ResultsBetween August 1, 2013, and December 31, 2015, there were 434 754 payments totaling $39.7 million in nonresearch-based opioid marketing distributed to 67 507 physicians across 2208 US counties. After adjustment for county-level sociodemographic factors, mortality from opioid overdoses increased with each 1-SD increase in marketing value in dollars per capita (adjusted relative risk, 1.09; 95% CI, 1.05-1.12), number of payments to physicians per capita (adjusted relative risk, 1.18; 95% CI, 1.14-1.21, and number of physicians receiving marketing per capita (adjusted relative risk, 1.12; 95% CI, 1.08-1.16). Opioid prescribing rates also increased with marketing and partially mediated the association between marketing and mortality.Conclusions and RelevanceIn this study, across US counties, marketing of opioid products to physicians was associated with increased opioid prescribing and, subsequently, with elevated mortality from overdoses. Amid a national opioid overdose crisis, reexamining the influence of the pharmaceutical industry may be warranted.

Association between Industry Payments and Scholarly Impact among Academic Ophthalmologists

Purpose The aim of this article is to examine the association between industry payments to ophthalmologists and scholarly impact. Design Retrospective cross-sectional study. Methods All ophthalmology faculty at United States accredited ophthalmology residency programs were included in this study. The main exposure was industry payments to ophthalmologists in 2016, as reported in the Centers for Medicare and Medicaid Services Open Payments Database. The primary outcome was Hirsch index (H-index), a measure of scholarly impact. Results Among 1,653 academic ophthalmologists in our study, 1,225 (74%) received industry payments in 2016. We did not observe a difference between the mean H-index of ophthalmologists receiving any industry payments versus those not receiving any payments (p = 0.68). In analysis including only ophthalmologists who received industry payments, H-index differed significantly by payment amount: 12.6 for ophthalmologists receiving less than $100, 12.2 for those receiving $100 to 1,000, 18.8 for those receiving $1,000 to 10,000, 21.3 for those receiving $10,000 to 100,000, and 29.4 for those receiving greater than $100,000 (p < 0.001). Within each academic rank and gender, industry payments greater than $1,000 were associated with a higher H-index (p < 0.05). Conclusions Although our analysis cannot prove causality, we observed a significant association between industry payments and scholarly impact among academic ophthalmologists, even after adjusting for gender, academic rank, and subspecialty. Prospective studies should further evaluate this relationship.

Analysis of current financial relationships between emergency physicians and industry

ObjectiveCharacterize the frequency and magnitude of all categories of publicly reported financial payments made to emergency physicians (EPs) in the United States (U.S.) in 2017. MethodsThis cross-sectional study of the 2017 Centers for Medicare and Medicaid Services Open Payments Database was exempt from Institutional Review Board Review. We calculated descriptive statistics of the frequency, type, and amount (medians) of general, research, and ownerships transactions made to EPs from industry, described regional differences of median payments to EPs, and characterized the drugs or devices most commonly associated with transactions. ResultsIn 2017, among 40,899 practicing U.S. EPs, 14,447 (35.4%) received 51,870 general payments from industry totaling $12,870,832. The median per-physician payment was $18.30 (interquartile range [IQR], $13.63–$60.90). The most frequent transaction was food and beverage (89.6%), though most payments by dollar amount were related to speaker and consulting fees (74.5%). Antithrombotics were the most frequently drug or device associated with transactions. Only 35 (0.08%) and 20 (0.05%) EPs had research and ownership relationships with industry, respectively. A significant difference was observed in median payments per physician across all U.S. Census regions (p < 0.01) except when comparing Northeast and West (p = 1.00). ConclusionsOver one-third of U.S. EPs had general payments from industry in 2017, while <1% of EPs had either research and ownership payments during this time period. Consistent with previous research, most payments to EPs are of low monetary value. Antithrombotics remain the most frequent drug associated with payments to EPs.

Assessment of Pharmaceutical Company and Device Manufacturer Payments to Gastroenterologists and Their Participation in Clinical Practice Guideline Panels

Payments from pharmaceutical and device manufacturers to physicians may influence the advice physicians give patients and peers. To investigate the nature and amounts of monetary and other benefits that gastroenterologists received and to determine the participation of those receiving benefits in the formulation of clinical practice guidelines. This cohort study analyzed information from the Centers for Medicare & Medicaid Services Open Payments database, including all reports about payments that pharmaceutical and device manufacturers gave to adult or pediatric gastroenterologists in 2016. PubMed was used to examine the professional affiliations and publication records of top payment recipients. Panelists of clinical guidelines who also received personal financial rewards listed in the Open Payments database were identified. Payments made to gastroenterologists by pharmaceutical company and device manufacturers. Of 15 497 gastroenterologists, 13 467 (86.9%) received a total of 432 463 payments accounting for a total expenditure of $67 144 862. Direct financial payments for consultations, talks, or other services were made to 2055 physicians and were responsible for 4.2% of payments (18 179 of 432 463), but for 62.7% of total expenditures ($42 086 207 of $67 144 862). Although a significant number of submissions were for food and beverages, they constituted only a small amount of total expenditure. For gastroenterologists treating adult patients, 10 products were linked to 63.8% of payments (11 221 of 17 588) related to direct financial rewards and 37.1% of the total expenditures ($24 892 643 of $67 144 862). Twenty-nine of 36 clinical practice guidelines included panelists who had received honoraria or consultation fees from industry sources, with amounts exceeding $10 000 in 8 of them (22%). Most gastroenterologists accept meals or gifts from industry, with 2055 of 15 497 gastroenterologists receiving direct payments and 8 of 36 clinical practice guidelines panelists having received more than $10 000. Considering the known impact of such benefits on prescribing patterns and other professional behaviors, policy makers should consider revising regulations governing interactions with industry and disclosure formats alerting others to their potential biasing impact.

Scope and Prevalence of Conflicts of Interest Among Highly Cited Peripheral Artery Disease Research Studies

Conflicts of interest (COI) potentially influence interpretation of study results for both authors and journal readers. Scientific journals often require author disclosure of relevant conflicts, but this is usually by self-report and seldom includes detailed quantification of reimbursement. The purpose of this analysis was to characterize COI among highly cited research studies related to peripheral artery disease (PAD) in terms of prevalence, quantity of reimbursement, and associations with manuscript characteristics. Highly cited PAD publications from 2012 to 2017 were identified through a Web of Science search using “peripheral artery disease.” Results were then sorted by number of times cited from highest to lowest. Review articles and non-English language publications were excluded. The top 100 most-cited publications were then abstracted for disclosed COI by author. Articles were characterized as basic science or clinical, and clinical publications were subcategorized as observational, medical interventions, or procedural interventions. Disclosures by US authors were queried using the ProPublica Dollars for Docs search tool (linked to the Centers for Medicare and Medicaid Services Open Payments data) based on provider name, specialty, and geographic location. Statistical analysis included descriptive statistics and categorical tests, including the χ2 test. Included publications were cited a mean of 124 ± 200.5 times and had a total of 1137 named authors. A mean of 1.6 ± 4.8 disclosed COI per author were identified. The prevalence of disclosed COI was significantly higher for clinical versus basic science studies (32.1% vs 4.2%; P < .0001). Among the top 10 articles by highest mean number of disclosures per author, the median open payment amount among authors reporting COI was $121,500 (range, $22-$2,630,000), and a total of $1,584,727 in nondisclosed open payments were identified from authors reporting no COI (median, $24,573; range, $12-$457,000). Disclosed COI sorted by journal are shown in the Table. Significant COI were identified among highly cited PAD studies, although the majority of authors reported none. Disclosed COI are significantly more prevalent among clinical versus basic science studies. Authors may have substantial nondisclosed compensation from industry that may be relevant to study results and interpretation. These results suggest that author self-reported COI may be conservatively biased. Readers should consider potential COI, including quantity of author compensation, when interpreting study results.TableMean number of disclosed conflicts of interest (COI) per author among highly cited peripheral artery disease (PAD) studies sorted by journalaJournalJournal Impact Factor (JCR 2017)Total no. of authorsMean COI per authorStandard deviationRangeStroke6.239109.75.50-17New England Journal of Medicine79.258805.990-41Journal of the American College of Cardiology16.8341303.57.10-44American Journal of Medicine5.117234.66.90-21Journal of Endovascular Therapy2.732262.23.50-18Arteriosclerosis Thrombosis and Vascular Biology6.086153.24.50-14JACC Cardiovascular Interventions9.88192.84.40-14Lancet Diabetes and Endocrinology19.313102.53.40-11European Heart Journal23.425462.46.20-30JACC-Cardiovascular Interventions9.881751.94.40-32Circulation18.881311.84.70-37Leukemia10.023161.630-11Annals of Neurology10.244241.14.20-20Journal of the American Medical Association10.244490.82.10-9Catheterization and Cardiovascular Interventions2.60260.50.80-2Journal of the American Society of Nephrology8.655180.51.50-5Journal of Thoracic and Cardiovascular Surgery4.8860.51.20-3Hypertension6.823180.41.40-6Journal of Cardiovascular Surgery1.19550.40.50-1Lancet53.254480.31.60-11Cardiovascular Drugs and Therapy2.77190.20.40-1Journal of Vascular Surgery3.294140.20.60-2Pharmacological Research4.897110.20.40-1Journal of the American Heart Association4.45400.10.20-1aJournals with highly cited studies but zero COI were excluded. Open table in a new tab

Industry Payments in Cardiology: A Cross-sectional Analysis of Open Payments Data.

The goal of Open Payments and the Physician Payments Sunshine Act is to foster transparency and accountability to help stakeholders better understand financial ties between physicians and teaching hospitals and the pharmaceutical and medical device industries. To evaluate the nature of industry relationships among cardiologists using the Open Payments database. The authors used the Centers for Medicare & Medicaid Services Open Payments data for calendar year 2015 to evaluate the financial relationship between cardiologists and medical industries (manufacturers of medications, devices, biologics, and medical supplies). The database used in this specific investigation included general payments reported for 2015. Payments were broken down by totals, type, company, and range. In the 2015 calendar year, 81,977 payments were made to 12,078 cardiologists, amounting to $13,906,167.43. The minimum payment made to a cardiologist was $1.16 and the maximum, $2,805,825. The most frequent category was $11 to $50, with 53,722 payments made (65.5%), followed by less than $10, with 12,307 payments made (15.0%). Payments to cardiologists were highly variable. Additional studies regarding the effects of these payments may be warranted.

Shining Sunlight on Industry Payments in Oral and Maxillofacial Surgery: The Sunshine Act

To characterize industry payments to oral and maxillofacial surgeons (OMSs) and to determine the accuracy of the Centers for Medicare and Medicaid Services (CMS) Open Payments Databases. This was a cross-sectional study of the CMS General and Research Payments Databases in 2016 for clinicians categorized as OMSs. General payments include consulting fees, honoraria, gifts, entertainment, food and beverage, travel and education, and others. Research payments include payments associated with research. Variables collected included number of OMSs who received payments, type of and number of payments, total amount paid, geographic distribution, and proportion of funding allotted to research. The accuracy of payee categorization was determined by verifying a random selection of 5% of those categorized as "OMS" in the database with publicly available data. To assess impact on research productivity, the h-index of research payment recipients was calculated. A total of 6,720 OMSs received industry compensation in 2016. Accuracy was 88% in the General Payments Database and 50% in the Research Payments Database. OMSs received 28,456 general payments totaling $5,971,800.79. The average number of payments and the average amount per payment were 4.27 and $1,597.60, respectively. The CMS reported total research payments of $23,592.17. The 4 verified OMSs received a total of $18,500 in research payments and had an average h-index of 3.25 (range, 0 to 8). The most common payments made were for food and beverage (80.2%), travel and lodging (5.83%), education (3.91%), compensation for services other than consulting (3.1%), and gifts (3.03%). Research accounted for 0.07% of all payments. Although industry payments to OMSs were common, research funding was negligible. Most industry value transfers were related to food and beverage or travel and lodging. Clinicians were accurately classified in the CMS General Payments Database but not in the Research Payments Database.

Leaders in Urologic Education and Their Relationship to Industry: An Analysis of Sunshine Act Open Payments From 2014-2016

To examine trends in the financial relationship between biomedical companies and leaders in urologic education during the first 3 full calendar years since implementation of the Sunshine Act. All accredited American Urological Association (AUA) residency programs were identified using the AUA website. Urology program directors and department chairs of the affiliated institutions were identified using residency program or urology department websites. Urology journal editors who practice in the United States were identified using the SCImago Journal & Country Rank website. All identified individuals were categorized by urologic subspecialty and AUA region based on information stated on their corresponding websites. Payment data for each individual from 2014 to 2016 was accessed using the Centers for Medicare and Medicaid Services Open Payments website, and statistical analyses were performed to elucidate trends based on leadership position, urologic specialty, AUA region, payment type, and overall payments over time. Out of the 239 urologists identified, 85%, 78%, and 91% received some sort of payment in 2014, 2015, and 2016, respectively. Department chairs accepted payments more readily than program directors and journal editors in all years. Average total payments for all urologists increased yearly, with mean general payments trending down and mean research payments trending up. The Sunshine Act was passed in part to promote transparency of the physician-industry relationship. Though the proportion of urologic leaders accepting payments between 2014 and 2016 did not change significantly, increased public scrutiny could have contributed to the decrease in yearly general payments and the increase in yearly research payments.

Comparison of Conflict of Interest (COI) Disclosures to Publicly Reported Industry Payments for Presenters at the American Society of Radiation Oncology (ASTRO) Annual Meeting: Can we Do Better?

The ASTRO annual meeting is the largest US academic forum for radiation oncology. Proper conflict of interest (COI) disclosure by speakers is essential to research integrity. We examine presentations at ASTRO annual meetings to evaluate COI disclosure and compare these disclosures to payments reported on the Centers for Medicare and Medicaid Services Open Payments (OP) database. In this abstract, we report on disclosure discrepancies and quantitative monetary thresholds of these discrepancies. The first presentation of each podium, scientific, presidential symposium, educational and panel session from the 2014-2016 ASTRO virtual meetings was arbitrarily selected. Each presentation was examined 1) for the presence of a COI slide and 2) for the disclosures listed. For each presenter, disclosures were cross-referenced with the OP database in the prior year in the categories of consulting, research, and faculty/speaking fees. Disclosures were determined to be discrepancies if a speaker did not list all the companies from which they received a payment as reported on the OP database, or if no COI slide was present. Of the 401 total presentations examined, 264 were US MDs, and 16.4% of US MDs underreported industry funding. When examining individual payments for all US presenters, 96 payments were reported on the OP database in the aforementioned categories: 53 of these payments were not disclosed and 43 payments were accurately disclosed. Of the presentations with discrepancies, 32.6% did not have a COI slide, 39.5% failed to disclose any OP companies, and 27.9% disclosed some but not all OP companies. Mean payment was $34,264 (median: $4,000; range: $96-$488,931), mean discrepancy was $30,300 (median: $2,925; range: $96-$488,931) and mean disclosed payment was $39,151 (median: $5,000; range: $750-$400,000). Research payments were the largest with a mean of $71,167 (median: $13,566; range: $160-$488,931). Among discrepancies, 49.1% were for research, 30.2% for consulting, and 20.8% for faculty/speaking fees. Three-quarters of the lowest third of all payments ($96-$2000) were not disclosed with the majority (75%) of these discrepancies occurring in presentations with COI slides while 45.3% of the upper two thirds of payments were not disclosed with 41.3% occurring in presentations with COI slides. A large minority of presenters underreported COIs. Payments of lower amounts were more often underreported. Limitations of our study include the small sample size and potential errors in reporting on OP. Nearly a third of discrepancies were due to absent COI slides, suggesting inadequate understanding of disclosure protocols. Guidelines should be revised with an emphasis on the dollar amount relevant for disclosing industry payments.

Meaningful and Accurate Disclosure of Conflict of Interest at the ASTRO National Meeting: A Need for Reassessment of Current Policies.

Conflict of interest (COI) disclosure is essential to research integrity. The average reading comprehension in English is 3.8 words per second (wps). This study examines presenters at the American Society for Radiation Oncology (ASTRO) national meeting over a recent 3-year period to determine whether disclosure is presented accurately and in a manner that allows the audience to comprehend the content. We examined videos of presentations as well as slides from 2014 to 2016 from the ASTRO virtual meeting, noting whether a COI slide was presented, the duration the slide was visible, and the number of disclosures. Disclosures were cross-referenced for discrepancies with the publicly reported Centers for Medicare and Medicaid Services Open Payments database. Using a cutoff of 4 wps, we noted how many presentations were presented at speeds of ≤ 4 wps and > 4 wps. The final data set consisted of 401 presentations delivered by 364 presenters. Using a threshold of 4 wps, 34.0% of presenters had COI slides shown too fast for the average audience to comprehend. Moreover, 16.3% of US physicians incorrectly underreported industry funding received. Of these presentations with discrepancies, 32.6% did not have a COI slide, 39.5% failed to disclose any COI, 27.9% partially disclosed COIs, and 11.6% contained multiple discrepancies. The number of wps were correlated with having a discrepancy on multivariable regression ( P = .046; odds ratio, 1.08; 95% CI, 1.01 to 1.19). A substantial minority of presentations at ASTRO lack meaningful disclosure, and a surprising number incorrectly reported COIs. Additional guidance may be needed to promote more meaningful and accurate disclosure of COIs at major national meetings in oncology.

Industry Payments to Obstetricians and Gynecologists Under the Sunshine Act.

To evaluate financial relationships between obstetrician-gynecologists (ob-gyns) and industry, including the prevalence, magnitude, and the nature of payments. We conducted a cross-sectional study in which we obtained a list of industry contributions to U.S. obstetricians and gynecologists through the Centers for Medicare and Medicaid Services Open Payments Database from August 1, 2013, to December 31, 2015. These data were cross-referenced with the entire cohort of practicing obstetricians and gynecologists, who were identified using the National Provider Identification database, because not all practicing ob-gyns received payments. These payments were analyzed with respect to 1) types of payments, 2) demographic attributes of health care providers receiving payments, and 3) comparisons between obstetrician and gynecologist subspecialties. Continuous data were compared using the Mann-Whitney test for variables that were not normally distributed and with the t test for variables that are normally distributed. A total of 517,077 nonresearch payments, totaling $79,965,244, were made to 23,292 ob-gyns. Physicians receiving payments were predominantly female, younger than 65 years old, allopathic physicians who graduated from U.S. medical schools in the late 1990s, and were board-certified subspecialists (P<.001 for all). Half of all ob-gyns received payments of varying amounts from drug manufacturers, device manufacturers, or both, with most of the payments for honoraria, faculty compensation, or consulting. Female pelvic medicine and reconstructive surgery physicians received the largest median dollar amount; maternal-fetal medicine physicians received the smallest. Obstetricians and gynecologists receive a substantial amount of payments from industry. Most of these payments were for honoraria, faculty compensation, or consulting and totaled less than $400 per health care provider. Although this total amount is less than typically received by surgical providers, including orthopedic surgeons who account for the highest compensated group in total and mean industry payments, the median payment value for obstetrics and gynecology subspecialists surpasses the median payment to orthopedic surgeons. These financial relationships warrant further exploration with future research.

The role of industry influence in sinus balloon dilation: Trends over time.

Balloon dilation (BD) is a controversial alternative to conventional sinus surgery. The role of industry on practice patterns remains unknown. The aim of this study was to determine whether industry payments from BD manufacturers influence practice patterns for otolaryngologists and evaluate how these payments change over time. Retrospective cohort study using Medicare Provider Utilization and Payment (PUP) Data and Center for Medicare and Medicaid Services Open Payments (OP) general payment datasets. A total of 294 otolaryngologists identified in the PUP dataset who performed BD procedures from January 1, 2013, to December 31, 2015, were cross-referenced in the OP dataset from January 1, 2014, to December 31, 2016, for BD manufacturer payments. Payments to surgeons performing BD stratified by amount, type, and number of procedures performed were primary outcome measures. Of the 294 otolaryngologists reporting BD procedures, 223 (76%) received payments from a company that manufactures BD devices. Receipt of $2,500 in BD payments was associated with performance of one additional BD procedure, and consulting fees were most positively associated with performing additional BD procedures (P = 0.006). The providers receiving the most in BD payments were more likely to continue to receive the most in payments, regardless of number of BD procedures performed. Performing more BD procedures did not correlate with decrease in other sinus procedures. Payments to otolaryngologists from manufacturers of sinus BD devices are associated with the performance of an increased number of such procedures. Surgeons should consider the impact of interactions with industry when evaluating patients for BD procedures. 4. Laryngoscope, 128:1540-1545, 2018.

Financial relationships between neurologists and industry

To analyze research and nonresearch payments from the pharmaceutical and device industry to neurologists in 2015 using the Centers for Medicare and Medicaid Services (CMS) Open Payments database. In this retrospective database analysis, we computed the percentage of neurologists in the United States receiving payments, the median/mean payments per neurologist, payment categories, regional trends, and sponsors. We computed the number of practicing neurologists from the Association of American Medical Colleges State Physician Workforce data book, 2015. In 2015, approximately 51% of US neurologists received nonresearch payments totaling $6,210,414. The median payment per physician was $81. Payments to the top 10% of compensated neurologists amounted to $5,278,852 (84.5%). Food and beverage was the most frequent category (86.5% of the total number of payments). The highest amount was paid for serving as faculty/speaker for noncontinuing medical education activities (58%). The top sponsor of nonresearch payments was Teva Pharmaceuticals ($1,162,900; 18.5%). A total of 412 neurologists received $2,921,611 in research payments (median $1,132). Multiple sclerosis specialists received the largest proportion ($285,537; 9.7%). Daiichi Sankyo paid the largest amount in research payments ($826,029; 28%). The Open Payments program was established to foster transparent disclosure of physician compensation from industry, in response to legislative and public concerns over the effect of conflicts of interest on practice, education, and research. The effects of this program remain unclear and studies of changes in prescribing practices, costs, and other outcomes are necessary. CMS should ensure that incorrect information can be rectified quickly and easily.

Conflict-of-Interest Disclosures to The Journal of Bone & Joint Surgery: The Relevance of Industry-Reported Payments.

Academic journals such as The Journal of Bone & Joint Surgery (JBJS) require disclosures of financial relationships that authors report as potential conflicts of interest. Because industry payments can take various forms, including food and beverage, consulting, or research payments, the purpose of this study was to determine which categories of industry-reported payments were most frequently considered by authors as irrelevant to their specific publication, and therefore not included in their journal disclosures. Author disclosures were collected from scientific articles published in JBJS in 2016. Payments reported by authors as relevant to the published article were compared with industry-reported payments from the Centers for Medicare & Medicaid Services Open Payments Database (OPD), which includes all payments to eligible physicians in the United States. The number of authors with payments found in the OPD and appearing in publication-specific disclosures was determined for each payment type. Of note, OPD data are not indicative of relevance to a particular publication; therefore, the accuracy of author disclosures could not be determined in this study. A total of 747 eligible authors were included; 60.5% of authors did not report at least 1 payment from their OPD report in their publication-specific disclosures, most frequently representing industry payments for food and beverage (55.7%), followed by travel and lodging (26.9%). Payments for consulting (16.3%), royalties (8.2%), research (8.4%), and ownership interests (1.5%) were not considered to be relevant disclosures for specific journal articles by authors at lower rates than those for food and beverage and for travel and lodging. Authors publishing in JBJS were more likely to conclude that industry-reported payments in the OPD for food and beverage and for travel and lodging were irrelevant for specific publications (as disclosed to the journal) than payments for consulting, royalties, research, and ownership interests.

Identifying Sources of Funding That Contribute to Scholastic Productivity in Academic Plastic Surgeons.

Scholastic productivity has previously been shown to be positively associated with National Institute of Health (NIH) grants and industry funding. This study examines whether society, industry, or federal funding contributes toward academic productivity as measured by scholastic output of academic plastic surgeons. Institution Web sites were used to acquire academic attributes of full-time academic plastic surgeons. The Center for Medicare and Medicaid Services Open Payment database, NIH reporter, the Plastic Surgery Foundation (PSF), and American Association of Plastic Surgeons (AAPS) Web sites were accessed for funding and endowment details. Bibliometric data of each surgeon were then collected via Scopus to ascertain strengths of association with each source. Multiple linear regression analysis was used to identify significant contributors to high scholastic output. We identified 935 academic plastic surgeons with 94 (10.1%), 24 (2.6%), 724 (77.4%), and 62 (6.6%) receiving funding from PSF, AAPS, industry, and NIH, respectively. There were positive correlations in receiving NIH, PSF, and/or AAPS funding (P < 0.001), whereas industry funding was found to negatively associate with PSF (r = -0.75, P = 0.022) grants. The NIH R award was consistently found to be the most predictive of academic output across bibliometrics, followed by the AAPS academic scholarship award. Conventional measures of academic seniority remained predictive across all measures used. Our study demonstrates for the first time interactions between industry, federal, and association funding. The NIH R award was the strongest determinant of high scholastic productivity. Recognition through AAPS academic scholarships seemed to associate with subsequent success in NIH funding.

Increasing Industry Support Is Associated with Higher Research Productivity in Orthopaedic Surgery.

Orthopaedic surgeons receive a disproportionately small share of funding from the National Institutes of Health, but they receive the largest amount of funding from industry sources. The purpose of this study was to examine the association between payments from industry partners and research productivity among orthopaedic research authors, as well as to identify predictors of high research productivity. United States-based physicians who published an article in 2016 in The Journal of Bone & Joint Surgery or The American Journal of Sports Medicine were included in this study. These authors were queried in the Centers for Medicare & Medicaid Services Open Payments database (OPD) to determine the amount of industry payments received, and on Scopus, a bibliometric web site, to assess the quantity (total publication count) and quality (Hirsch index [h-index]) of each author's research. Nonparametric testing was used to compare the h-index and the total publication count of authors by payments received and academic position. Multivariate regression was used to identify independent predictors of high research productivity. Of the 766 included authors, 494 (64.5%) received <$10,000 per year, 162 (21.1%) received between $10,000 and $100,000, and 110 (14.4%) received >$100,000 in total payments. The h-index increased significantly from a mean (and standard deviation) of 13.1 ± 12.9 to 20.9 ± 14.4, and to 32.3 ± 16.7, from the lowest to highest payment cohorts, as did total publication count. When authors were stratified by academic position (assistant professor, associate professor, full professor, and nonacademic), those who received more industry payments (>$100,000) had a higher h-index and total publication count at all academic levels relative to lower-earning (<$10,000) authors. Independent predictors of a high h-index included industry payments of between $10,000 and $100,000 (odds ratio [OR], 1.63; p = 0.048), payments of >$100,000 (OR, 5.87), associate professorship (OR, 6.53), full professorship (OR, 33.38), and last authorship (OR, 2.22) (p < 0.001 for all comparisons unless otherwise noted). Although this study does not establish a causal relationship, we identified increasing industry payments as an independent predictor of research productivity among authors at all academic levels who had published peer-reviewed orthopaedic research.

Accuracy Between AJSM Author-Reported Disclosures and the Centers for Medicare and Medicaid Services Open Payments Database

Background: Inaccurate disclosures of physician and industry relationships in scientific reporting may create an asymmetry of information by hiding potential biases. The accuracy of conflict of interest disclosure in sports medicine research is unknown. Purpose: To compare author financial disclosures in published articles in 2016 in the American Journal of Sports Medicine (AJSM) with the Centers for Medicare and Medicaid Services’ Open Payments Database (OPD) to determine the percentage of payments values and percentage of eligible authors with discrepancies. Study Design: Cross-sectional study; no level of evidence (nonclinical). Methods: All articles published in 2016 in AJSM were screened to identify eligible authors. On the basis of OPD reporting, physician authors affiliated with a US institution were included. Stated disclosures in AJSM publications for these authors were identified and compared with industry-reported payments on OPD. Results: A total of 434 authors were included in this study. Mean and median total payments per author per year were $76,941 and $1692, respectively. The most commonly received payment was for food and beverage (81.3% of authors), followed by travel and lodging (45.4%) and consulting (31.8%). Authors with higher total payments were less likely to be discrepant in their reporting—notably, authors earning >$500,000 had 16.1% of payment values with discrepancy, as opposed to 85.3% for those earning <$10,000 (P < .001). First authors had a lower percentage of payment values with discrepancy (13.8%) versus middle authors (31.9%, P = .001). Finally, men had a lower percentage of payment values with discrepancy (418 authors, 22.3% of payment values with discrepancy) as compared with women (16 authors, 95.3%; P < .001). Regarding industry payments specifically requested on the AJSM disclosure form for authors (royalties, consulting, research payments, and ownership and investments), only 25.3% of authors had a discrepancy in these payment categories in aggregate. Conclusion: Discrepancies exist between disclosures reported by authors publishing in AJSM and what is reported in the OPD. Authors receiving lower total payments, middle authors, and women are more likely to have disclosure discrepancies. Additionally, industry research funding support and ownership interest are most likely to go unreported. However, this study did not assess whether authors with industry payments preferentially published studies pertaining to products from companies from which they received funding. As national registries such as the OPD are increasingly utilized, physicians may benefit from referencing such databases before submitting conflict of interest disclosures.

An Evaluation of Industry Relationships Among Contributors to AAOS Clinical Practice Guidelines and Appropriate Use Criteria.

A long-standing relationship between orthopaedic surgeons and industry has made financial conflicts of interest a concerning issue. Research supports that financial conflicts of interest can influence both medical research and clinical practice. Financial conflicts of interest may also influence clinical practice guideline recommendations and their corresponding appropriate use criteria. Because of the influential nature of these guidelines, it is imperative that care be taken to minimize bias during guideline development. We retrieved clinical practice guidelines and their corresponding appropriate use criteria from the American Academy of Orthopaedic Surgery that were published or revised between 2013 and 2016. We extracted industry payments received by physicians using the Centers for Medicare & Medicaid Services Open Payments database. We then evaluated the value and types of these payments. We also used these data to determine whether disclosure statements were accurate and whether guideline development was in adherence with the Institute of Medicine's (IOM's) standards. Of the 106 physicians that were evaluated, 85 (80%) received at least 1 industry payment, 56 (53%) accepted >$1,000, and 35 (33%) accepted >$10,000. Financial payments amounted to a mean of $93,512 per physician. Total reimbursement for the 85 clinical practice guideline and appropriate use criteria contributors was $9,912,309. We found that disclosure statements disagreed with the Open Payments data and that the IOM standards were not completely enforced. Clinical practice guideline and appropriate use criteria contributors received substantial payments from industry, many disclosure statements were inaccurate, and the IOM standards were not completely met. Clinical practice guidelines and appropriate use criteria are critical for practicing evidence-based medicine. If financial conflicts of interest are present during their development, it is possible that patient care may be compromised.