Distribution, characteristics of industry payments varied among specialties

Researchers studied 2.43 million payments totaling $475 million received by allopathic and osteopathic physicians.

From the first release of CMS’ Open Payments program, which includes data from the latter half of 2013, researchers found the distribution and characteristics of industry payments varied widely by physician specialty.

“As transparency of industry payments is growing considerably for physicians, it is important for us to understand how the patterns of payments vary by specialty,” Jona A. Hattangadi-Gluth, MD, assistant professor and researcher at the University of California, San Diego, told Orthopedics Today. “There was considerable variability among specialties not only by payment amount but also by payment context.”

Specialty variability

In a retrospective analysis, Hattangadi-Gluth and her colleagues searched the most recent available release of Open Payments data on industry payments to physicians made between August 2013 and December 2013. Such payments were compared between specialty types and across specialties within each type. Comparisons were also made between the number of physicians who received payments with the total number of active physicians in each specialty in 2012. Physician-held ownership interest in reporting companies was also were analyzed.

Overall, researchers found 2.4 million payments totaling $475 million received by identified allopathic and osteopathic physicians. Although results showed internal medicine and orthopedic surgery specialties received the greatest total value ($111 million each), this amount was distributed to a greater number of internal medicine physicians (77,515 vs. 15,459). The per-physician value of payments was highest in orthopedic surgery. Cardiovascular disease and gastroenterology received the greatest number of payments.

General payments represented 90% of the total value of payments with the remaining 10% distributed as research payments. The highest median general payments was found in thoracic surgery, cardiovascular disease and urology while the highest mean value of general payments per physician was found in orthopedic surgery, neurosurgery and neurology.

With respect to ownership interests, the researchers observed significant differences in the total dollar amount invested, total values of interest and the proportion of physicians with ownership interest among specialty types and by specialty within each type. Urology, neurosurgery and orthopedic surgery were most likely to have ownership interests with manufacturers.

“We were surprised at the degree of variability across specialties, and tried to make sense of these within their specialty-specific context. Our data suggests that specialties with a greater amount of intervention like cardiovascular specialties and orthopedic surgery received a greater value of payments from industry, implying a closer relationship with device and drug companies,” Hattangadi-Gluth said. “We also found that payments for royalty and license fees made up a considerable proportion of value in surgical specialties, indicating a close relationship with device development in these fields.”.”

Relationship benefits

While orthopedic surgery received high payments per physician as well as some of the highest median value of ownership interest and royalty and license payments, Hattangadi-Gluth noted orthopedic surgeons being involved with manufacturers is not inherently bad for patients.

“It is important to recognize that orthopedic surgery is a field that depends on close interaction between surgeons and device manufacturers, and in many ways this fosters innovation and benefits patient care,” she said. “However, some financial conflicts of interest may be problematic if they misappropriate the utilization of care or drive up the costs of care. Further studies incorporating quality and utilization data, especially in orthopedics, will help improve our understanding of industry-physician financial relationships and how these may affect the healthcare system.” – by Casey Tingle

Reference:

Marshall DC, et al. Mayo Clin Proc. 2016;doi:10.1016/j.mayocp.2015.10.016.

For more information:

Jona A. Hattangadi-Gluth, MD, can be reached at the Department of Radiation Medicine and Applied Sciences, Moores Cancer Center, University of California, San Diego, 3960 Health Sciences Dr., #0865, La Jolla, CA 92093; email: jhattangadi@ucsd.edu.

Disclosure: Hattangadi-Gluth reports he has no relevant financial disclosures.