Open Payments Data Research Articles

"Academic Influence and Industry Funding in Nerve Allograft Research: A Co-Authorship Network Analysis".

Clinical use of acellular nerve allografts is rapidly increasing despite limited high-quality, comparative evidence of superiority. Simultaneously, non-research payments to clinicians by the nerve allograft industry exceeds $14,000,000 over the last decade. In this study, the authors hypothesized that nerve allograft-related academic influence would correlate with industry funding. PubMed studies on nerve allografts in plastic and reconstructive surgery journals were reviewed. Using author lists from extracted studies, a co-authorship network was generated and degree centralities - quantitative measurements of influence within a network - were calculated. Open Payments data from the nerve allograft industry was summated for each author. Finally, Pearson correlation and linear regression were used to analyze the relationship between centrality and payments received. 185 studies were included, with 581 unique authors (nodes) and 2,406 co-authorships (ties) between them. Among authors with exceptional network influence (centrality >10, 75th percentile; n=113), 56 were clinicians with valid NPIs and therefore eligible for inclusion in the Open Payments database. 44 (79%) of these authors received at least one payment from the industry. Pearson correlation revealed a moderate (0.4<r<0.6) positive correlation between centrality and payments received (r=0.51, p<0.001). Linear regression demonstrated an estimated 16% increase in total pay per additional unit of centrality (p<0.001; 95% CI [8%, 25%]). There is a significant connection between academic influence and financial support from the nerve allograft industry. Such results warrant discussion concerning conflicts of interest in clinical research and best practices for mitigating potential bias related to commercially backed treatments.

Quantifying Industry Spending on Promotional Events Using Open Payments Data

Quantifying Industry Spending on Promotional Events Using Open Payments Data

726 Changes of Reported Industry Payments to Neurosurgeons Pre- and Post-Covid-19 Epidemic

INTRODUCTION: Under the Affordable Care Act, the Physcian Patient Sunshine Act was implemented in 2010, providing public transparency of industry relationships with physcians. Open Payments Data (OPD) was released in 2014, and annually since. Payments to Neurosurgeons have been found to be amongst the highest. However, the implications Covid-19 in 2020 had on payments has not been reported. METHODS: A retrospective study was performed from January 1, 2017 to December 31, 2021 of the Open Payments Database. Collected data included the total number of industry payments, the aggregate value of industry payments, and the mean value of each industry payment made to neurosurgeons per year over the 5-year period. RESULTS: A total of 7,985 unique neurosurgeons recieved payments, totaling $451,610,410, There was a decreasing trend in the number of Neurosurgeons recieving payments during Covid-19 (2020): 5,478 (2017), 5,286 (2018), 5,146 (2019), 4,330 (2020), and 4,880 (2021). Additionally, there was decline in the total amount of payments made in 2020, compared to the other years: 80,358 (2017), 82,143 (2018), 85,026 (2019), 46,762 (2020), and 67,507 (2021). Among the types of payments, year 2020 was lower than the other years in Food and Beverage, Travel and Lodging, Services other than Consulting, and Eduction. Interestingly, year 2020 had higher number of payments for Consulting Fee and Royalty/License payments compared to pre-Covid-19 years. CONCLUSIONS: Our study shows that over the 5-year period (2017-2021) of the Centers for Medicare and Medicaid Services OPD, there was decrease in number of Neurosurgeons recieving payments and the number of payments made to Neurosurgeons compared to Pre-Covid. However, 2021 demonstrated an increasing trend similar to Pre-Covid.

Biosimilars engage in low levels of direct-to-physician marketing relative to reference biologics.

Biosimilars have the potential to greatly reduce US spending on biologic drugs, but uptake of these competitor products varies. We used Open Payments data from 2014 to 2022 to proxy for direct-to-physician marketing and compared levels of activity between biologic and biosimilar drug manufacturers. Our analysis focused on 6 reference biologics that recently faced competition in the years immediately before and after the launch of the first biosimilar. We used Medicare Part B dosage units to measure market penetration of biosimilars and its relationship with biosimilar marketing activity. Last, we conducted a sensitivity test, comparing payments for primarily office- or hospital-based physicians, using affiliations constructed from Medicare Carrier claims. Reference biologic manufacturers greatly reduced the amount of direct-to-physician marketing in the post-launch period. Biosimilar manufacturers generally engaged in low levels of activity relative to the historic performance of reference biologics. These trends were consistent across office- and hospital-based physicians. The intensity of biosimilars' direct-to-physician marketing also had no apparent relationship with achieved market penetration. Our findings demonstrate that persistently high market shares of reference biologics cannot be explained by ongoing direct-to-physician marketing activities. At the same time, while such activities could educate physicians or induce switching, biosimilar entrants engaged in little direct-to-physician marketing.

Costs and Outcomes of Total Joint Arthroplasty in Medicare Beneficiaries Are Not Meaningfully Associated with Industry Payments.

Prior studies have demonstrated that industry payments affect physician prescribing patterns, but their effect on orthopaedic surgical costs is unknown. This study examines the relationship between industry payments and the total costs of primary total joint arthroplasty, as well as operating room cost, length of stay, 30-day mortality, and 30-day readmission. Open Payments data were matched across a 20% sample of Medicare-insured patients undergoing primary elective total hip arthroplasty (THA) (n = 130,872) performed by 7,539 surgeons or primary elective total knee arthroplasty (TKA) (n = 230,856) performed by 8,977 surgeons from 2013 to 2015. Patient, hospital, and surgeon-specific factors were gathered. Total and operating room costs, length of stay, mortality, and readmissions were recorded. Multivariable linear and logistic regression models were used to identify the risk-adjusted relationships between industry payments and the primary and secondary outcomes. In this study, 96.7% of THA surgeons and 97.4% of TKA surgeons received industry payments. After multivariable risk adjustment, for each $1,000 increase in industry payments, the total costs of THA increased by $0.50 (0.003% of total costs) and the operating room costs of THA increased by $0.20 (0.003% of total costs). Industry payments were not associated with TKA cost. Industry payments were not associated with 30-day mortality after either THA or TKA. Higher industry payments were independently associated with a marginal decrease in the length of stay for patients undergoing THA (0.0045 days per $1,000) or TKA (0.0035 days per $1,000) and a <0.1% increase in the odds of 30-day readmission after THA for every $1,000 in industry payments. The median total THA costs were $300 higher (p < 0.001), whereas the median TKA costs were $150 lower (p < 0.001), for surgeons receiving the highest 5% of industry payments. These surgical procedures were more often performed in large urban areas, in hospitals with a higher number of beds, with a higher wage index, and by more experienced surgeons and were associated with a 0.4 to 1-day shorter length of stay (p < 0.001). Although most arthroplasty surgeons received industry payments, a minority of surgeons received the majority of payments. Overall, arthroplasty costs and outcomes were not meaningfully impacted by industry relationships. Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Review of "Open Payments Data Analysis of General and Fellowship-trained Surgeons Receiving Industry General Payments From 2016 to 2020: Payment Disparities and COVID-19 Pandemic Impact" by Stantamaria-Barria et al, Annals of Surgery 2023;278(3):396-407.

Review of "Open Payments Data Analysis of General and Fellowship-trained Surgeons Receiving Industry General Payments From 2016 to 2020: Payment Disparities and COVID-19 Pandemic Impact" by Stantamaria-Barria et al, Annals of Surgery 2023;278(3):396-407.

Industry Payments Comparison Between Female and Male Mohs Surgeons From 2015 to 2021.

There are limited data on female Mohs surgeon industry relationships. To evaluate industry payment activity between female and male Mohs surgeons. A retrospective review of the U.S. Centers for Medicare and Medicaid Services open payments data was performed between 2015 and 2021 for Mohs surgeons in the United States. Gender, academic affiliation, practice region, annual total payment, cumulative payment, and industry payment type was collected. Male Mohs surgeons received higher mean total payments than female Mohs surgeons ( p = .04), which persisted when data were stratified based on industry payment type and practice region. Both genders had similar median total payments ( p = .4). Females in academic practice received higher mean total payments than those in private practice. Females experienced a significant lower mean total payment compared with males in the South ( p = .03). High total payments received by male Mohs surgeons skewed the data, which is supported by a significant mean total payment difference despite a similar median total payment distribution. Female Mohs surgeons receiving the top payments may address this mean payment difference. Females seem to have higher payments if they practice in the Northeast and are in academics. Further studies are needed to evaluate this payment gap.

40652 Trends in Industry Payments to Dermatologists: A Five-Year Analysis of the Open Payments Data

40652 Trends in Industry Payments to Dermatologists: A Five-Year Analysis of the Open Payments Data

Open Payments Data Analysis of General and Fellowship-trained Surgeons Receiving Industry General Payments from 2016 to 2020: Payment Disparities and COVID-19 Pandemic Impact.

To characterize industry non-research payments made to general and fellowship-trained surgeons between 2016-2020. The Centers for Medicare & Medicaid Services Open Payments Data (OPD) reports industry payments made to physicians related to drugs and medical devices. General payments are those not associated with research. OPD data were queried for general and fellowship-trained surgeons who received general payments from 2016 to 2020. Payments' nature, amount, company, covered product, and location were collected. Surgeons' demographics, subspecialty, and leadership roles in hospitals, societies, and editorial boards were evaluated. From 2016 to 2020, 44,700 general and fellowship-trained surgeons were paid $535,425,543 in 1,440,850 general payments. The median payment was $29.18. The most frequent payments were for food and beverage (76.6%) and travel and lodging (15.6%); however, the highest dollar payments were for consulting fees ($93,128,401; 17.4%), education ($88,404,531; 16.5%), royalty or license ($87,471,238; 16.3%), and travel and lodging ($66,333,149; 12.4%). Five companies made half of all payments ($265,654,522; 49.6%): Intuitive Surgical ($128,517,411; 24%), Boston Scientific ($48,094,570; 9%), Edwards Lifesciences ($41,835,544, 7.8%), Medtronic Vascular ($33,607,136; 6.3%), and W. L. Gore & Associates ($16,626,371; 3.1%). Medical devices comprised 74.7% of payments ($399,897,217), followed by drugs and biologicals ($33,945,300; 6.3%). TX, CA, FL, NY, and PA received the most payments; however, the top dollar payments were in CA ($65,702,579; 12.3%), MI ($52,990,904, 9.9%), TX ($39,362,131; 7.4%), MD ($37,611,959; 7%), and FL ($33,417,093, 6.2%). General surgery received the highest total payments ($245,031,174; 45.8%), followed by thoracic surgery ($167,806,514; 31.3%) and vascular surgery ($60,781,266; 11.4%). A total of 10,361 surgeons were paid >$5,000, of which 1,614 were women (15.6%); in this group, men received higher payments than women (means, $53,446 vs. $22,571; P<0.001) and thoracic surgeons received the highest payments (mean, $76,381; NS, P=0.14). A total of 120 surgeons were paid >$500,000 ($203,011,672; 38%) - 5 non-Hispanic white (NHW) women (4.2%) and 82 NHW (68.3%), 24 Asian (20%), 7 Hispanic (5.8%), and 2 Black (1.7%) men; in this group, men received higher payments than women (means, $1,735,570 vs. $684,224), and NHW men received payments double those of other men (means, $2,049,554 vs. $955,368; NS, P=0.087). Among these 120 highly paid surgeons (>$500,000), 55 held hospital and departmental leadership roles, 30 were leaders in surgical societies, 27 authored clinical guidelines, and 16 served on journal editorial boards. During COVID-19, 2020 experienced half the number of payments than the preceding 3 years. General and fellowship-trained surgeons received substantial industry non-research payments. Highest paid recipients were men. Further work is warranted in assessing how race, gender, and leadership roles influence the nature of industry payments and surgical practice. A significant decline in payments was observed early during the COVID-19 pandemic.

Academic productivity metrics correlate positively with industry funding amongst orthopedic shoulder and elbow surgeons

Research efforts can produce practice-changing results with widespread implications for patient care. While critical to the advancement of the field, such efforts do not often provide direct compensation. However, a researcher's academic productivity may facilitate industry relationships, either as the impetus for the affiliation or a result of collaboration. Queries of the Centers for Medicaid and Medicare Services publicly available Open Payments System allowed for extraction of industry compensation data for orthopedic surgeons in 7 categories, including royalties and licensing fees, consulting fees, gifts, honoria, and 3 unique speaking fees delineations. This system identifies physicians by taxonomy identifications; however, Centers for Medicaid and Medicare Services does not have a unique code for shoulder and elbow surgeons. Therefore, identification of shoulder and elbow surgeons proceeded utilizing the American Shoulder and Elbow Surgeons (ASES) society 2019 membership directory. Cross-referencing this membership list with extracted Open Payments data provided industry funding information for all ASES members. Physicians then underwent an academic productivity assessment. Queries of Web of Science, Scopus, and Google Scholar User Profile databases provided the Hirsch index (h-index) and m-index for each surgeon. Bivariate and multivariate analyses produced statistical results. From 2016 to 2020, 631,130, 158, and 72 ASES members earned mean annual industry compensation <$1000, between $1001 and $10,000, between $10,001 and $100,000, and >$100,000, respectively. Royalties (91.5%) predominated in the top earning group, compared with consulting fees (58.0%, 55.0%) in the 2 middle-tier groups. H-index and m-index correlated positively with total compensation (h-index: r=0.18, P<.001; m-index: r=0.10, P<.001). The highest income group (>$100,000) had higher h-index and m-index scores than either intermediate ($1001-$10,000, $10,001-$100,000) or lowest (<$1000) compensation groups (From lowest to highest income bracket-h-index: 14.8 vs. 16.4 vs. 19.4 vs. 32, P<.001; m-index: 0.79 vs. 0.85 vs. 0.91 vs. 1.18, P=.003). Multivariable analysis of factors associated with increased industry compensation identified only h-index (B=8046, P<.001) as having a significant association with physician compensation, with each single unit increase in h-index associated with an 18% increase in industry funding. Among a group of academic shoulder and elbow surgeons, industry compensation correlates positively with academic productivity metrics, with an associated $8046/yr increase in industry funding for each single-unit increase in h-index over 9. Future studies may focus on more clearly defining the causal directionality of these results.

Comparison of Industry Payments to Physicians and Advanced Practice Clinicians

This study uses Open Payments data to characterize and compare payments to physicians and advanced practice clinicians.

Physician Payments from Pharmaceutical Companies Related to Cancer Drugs.

BackgroundDrug manufacturers claim that the purpose of financial payments to physicians is to facilitate education about new drugs. This claim suggests 2 testable hypotheses: payments should not be associated with drug revenue and payments for each drug should decline over time as physicians become educated.Materials and MethodsWe used open payments data on industry payments. We included payments for cancer drugs without generic/biosimilar competitors and used federal data sources to measure Medicare spending (a proxy for overall drug revenue) and a number of prescribers. We used generalized estimating equations (GEE) to model the drug-level association between industry payments and Medicare spending. Separately, we used GEE to estimate the change in payments with respect to the duration of time since initial FDA approval.ResultsThe sample included 89 drugs and 361 drug-year observations. The total value of industry payments for oncology drugs increased, 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 to 0.004). Payments for individual drugs decreased over time; estimated payments in the subsequent year for a drug with mean, per-physician payments of $1000 in the index year was: $681* for drugs 0-4 years since approval, $825 for 5-9 years, and $679* for ≥10 years (*P < .05).ConclusionsAlthough industry-sponsored education may also serve marketing purposes, the absence of association between industry payments and Medicare spending and the decline in payments subsequent to approval are consistent with claims that industry payments function to facilitate physician education.

Industry Relationships With Medical Oncologists: Who Are the High-Payment Physicians?

Many oncologists have relationships with industry. Previous work has shown that these payments are usually modest; however, there exist a subset of medical oncologists who receive more than $100,000 US dollars (USD) annually. Here, we describe the characteristics of these physicians. This retrospective cohort study used the Open Payments data set to identify all US-based medical oncologists/hematologists who received $100,000+ USD in general payments linked to cancer medications in 2018. Open Payments and a web-based search were used to identify physician characteristics, demographics, research profile, and leadership positions. One hundred thirty-nine medical oncologists received > $100,000 USD in general payments. The median payment was $154,613 USD, and the total payment was $24.2 million USD. These high-payment physicians represent 1% of all US medical oncologists (N = 10,620) yet account for 37% of all industry payments in 2018. Sixty percent (84 of 139) and 21% (29 of 139) of these high-payment physicians hold hospital and specialty association leadership roles, respectively. One quarter (24%, 33 of 139) serve on journal editorial boards, and 10% (14 of 139) have authored clinical practice guidelines; 72% (100 of 139) hold faculty appointments. A small number of medical oncologists receive very high payments from the pharmaceutical industry. These physicians hold major leadership roles within oncology. Further work is needed to understand the extent to which these conflicts of interest may shape clinical practice and policy.

Association Between Payments by Pharmaceutical Manufacturers and Prescribing Behavior in Rheumatology

ObjectiveTo evaluate the association between pharmaceutical industry payments to rheumatologists and their prescribing behaviors. MethodsA cross-sectional analysis was conducted of Medicare Part B Public Use File, Medicare Part D Public Use File, and Open Payments data for 2013 to 2015. Prescription drugs responsible for 80% of the total Medicare pharmaceutical expenditures in rheumatology were analyzed. We calculated the mean annual drug cost per beneficiary per year, the percentage of rheumatologists who received payments, and the median annual payment per physician per drug per year. Industry payments were categorized as food/beverage and consulting/compensation. Multivariable regression models were used to assess associations between industry payments and both prescribing patterns and prescription drug expenditures. ResultsOf 4822 rheumatologists in the Medicare prescribing databases, 3729 received any payment from a pharmaceutical company during this time frame. Food/beverage payments were associated with an increased proportion of prescriptions for the related drugs (range, 1.5% to 4.5%) and an increased proportion of annual Medicare spending for the related drugs (range, 3% to 23%). For every $100 in food/beverage payments, the probability of prescribing increased (range, 1.5% to 14% for most drugs) and Medicare reimbursements increased (range, 6% to 44% for most drugs). Consulting/compensation payments were associated with an increased proportion of prescriptions (range, 1.2% to 1.6%) and an increased proportion of annual Medicare spending (range, 1% to 2%). For every $1000 in consulting/compensation payments, both the probability of prescribing increased (5% or less for most drugs) and Medicare reimbursements increased (less than 10% for most drugs). ConclusionPayments to rheumatologists by pharmaceutical companies are associated with increased probability of prescribing and Medicare spending.

Let's be honest, the perception is real

Let's be honest, the perception is real

Pharmaceutical opioid marketing and physician prescribing behavior.

Physicians' relationships with the pharmaceutical industry have recently come under public scrutiny, particularly in the context of opioid drug prescribing. This study examines the effect of doctor-industry marketing interactions on subsequent prescribing patterns of opioids using linked Medicare Part D and Open Payments data for the years 2014-2017. Results indicate that both the number and the dollar-value of marketing visits increase physicians' patented opioid claims. Furthermore, direct-to-physician marketing of safer abuse-deterrent formulations of opioids is the primary driver of positive and persistent spillovers on the prescribing of less safe generic opioids - a result that we show appears to be driven by insurance coverage policies. These findings suggest that pharmaceutical marketing efforts may have unintended public health implications.

Medical Device Firm Payments To Physicians Exceed What Drug Companies Pay Physicians, Target Surgical Specialists.

Many physicians receive payments from medical device companies that make products physicians can use or recommend. Such payments are controversial because of concerns that they might influence physicians to treat patients with devices made by the firms that make those payments, even if those devices are not optimal for patients. This issue has been studied extensively in the drug industry. Medical devices entail a greater degree of physician-industry interaction regarding treatment, training, and innovation than pharmaceuticals, and they have been less studied because of data limitations. We summarize and compare device and drug firm payment rates and magnitudes reported in Open Payments data by payment type, physician specialty, and Medicare billing amount. Relative to drug firm payments, device firm payments as a percentage of industry revenue were seven times as large; device firm payments were also more often related to product development and training and were more strongly correlated with physicians' Medicare billing amounts. Using Food and Drug Administration product approval data, we further document that top-paying firms dominate high-revenue device categories. Our results suggest that optimal policy regarding physician-industry relationships for medical devices may be very different from that for pharmaceuticals. Estimating the causal relationships between payments and device use, pricing, and innovation to inform policy makers will be possible only with greater data transparency, such as including device identifiers in medical claims.

Abstract 14058: Sex-based Differences in Reported Payments to Cardiologists by Drug and Device Manufacturers

Introduction: Sex-based disparities in salaries and promotion in cardiovascular medicine are well known, but there is little data on industry compensation by sex. We attempted to explore sex differences in financial ties to industry in the form of drug and device manufacturer payments to cardiologists. Methods: 2018 Open Payments data was obtained from Centers for Medicare and Medicaid Services (CMS). A cross walk was used to link CMS National Plan and Provider Enumeration System National Provider Identifier Data with open payments data. Physician specialty (adult cardiology), sex, state of practice, number and amount of payments, drug and device information were obtained and aggregated for analysis using natural language processing. Results: In 2018, total of 879,119 payments were made to 29246 physicians (10.2% female), totaling $145,556,106. Nationwide, female cardiologists had lower rates of payments (15.5 payments per year vs 25.9 payments), lower average compensation per payment ($113 vs $169) when compared to their male counterparts. Analysis of five drugs/devices with the largest aggregated payments revealed that the female representation in certain categories (consulting, compensation for serving as speaker-non continuing education, and travel and lodging) was far lower than expected (3.8%, 5.4%, and 4.2% respectively). Conclusions: Female cardiologists received fewer payments and lower compensation per payment from drug and device manufacturers as compared to their male counterparts. Further studies are required to determine reasons behind differences in compensation and efforts be made to standardize compensation regardless of sex to promote equal opportunities for all physicians.

Trends in Industry Payments to Physicians in the United States From 2014 to 2018

This study uses Medicare Open Payments data to characterize trends in the prevalence and value of physicians’ interactions with industry overall and by specialty between January 2014 and December 2018 after implementation of the federal Open Payments transparency program in 2013.

Promotional Payments Made to Urologists by the Pharmaceutical Industry and Prescribing Patterns for Targeted Therapies

To measure the association between market-level promotional payments to urologists by the manufacturers of abiraterone and enzalutamide and national prescribing patterns. A 20% national sample of the 2015 Part D event file was used to identify patients filling their first prescription for abiraterone and enzalutamide and their prescribing physicians. The 2015 Open Payments data were used to characterize promotional payments made to physicians at the market level. Generalized linear models were then used to measure the relationship between market-level payments to urologists and the physician specialty prescribing abiraterone or enzalutamide for the first time RESULTS: In 2015, 2318 men filled a prescription for abiraterone or enzalutamide by a urologist or medical oncologist. Increasing market-level promotional payments to urologists for abiraterone or enzalutamide was strongly associated with a urologist prescribing either drug-24.3% versus 5.8% of those residing in the markets with highest and lowest level of promotional payments to urologists, respectively (P <.01). Neither the number of urologists residing in a market nor other promotional payment measures (ie, to medical oncologists for these drugs, or to all physicians for all other drugs) were associated with a urologist prescribing either drug. Promotional payments to urologists at the market level are strongly associated with the specialty of the physician prescribing abiraterone or enzalutamide for the first time. Future work should elucidate the effects of the shift in prescribing patterns on quality of care and financial hardship for men with advanced prostate cancer.