The Sunshine Act and Surgeons: A Nation-Wide Analysis of Industry Payments to Physicians

Abstract

Background: The Physician Payments Sunshine Act mandates the submission of payment records between medical providers and industry. We used the Open Payments Program database to compare industry payments to surgeons and nonsurgeons, as well as among surgical specialties, and to identify geographic distribution of payments.

Materials and methods: We included all reported industry payments in the Centers for Medicare and Medicaid Services' Open Payments Program in the United States, 2014-2015. Multivariable regression fixed effects panel analysis of total payments was conducted among surgeons, adjusting for surgeon specialty, payor type, payment category, and state. A geographic heat map was created.

Results: Of 2,097,150 subjects meeting criteria, 1,957,528 (45.66%) were physicians. The mean standard deviation (SD) payment overall was $232.64 ($6262.00), and the state with the highest mean (SD) payment was Vermont at $2691.61 ($11,508.40). Surgeons numbered 153,916 (7.86%). The specialty with the highest mean (SD) payment was orthopedic surgery at $2811.50 ($33,632.71, P < 0.001). Among 2,097,150 subjects meeting criteria, in multivariable regression fixed effects panel analysis, orthopedic compared to general surgeons were significantly likely to receive more industry payments (beta $1065.34 [95% CI $279.00-1851.00, P = 0.008), even controlling for payor, payment type, and state. Significant geographic disparities in payment were noted as 12 states received the top mean ($24.52-$500,000.00), leaving seven states with the lowest ($0.00-$12.56).

Conclusions: There are significant differences in industry payments to surgeons versus nonsurgeons and among surgical specialties, as well geographic distribution of payments. These data may prompt further investigation into trends and their causality and effects on research and practice.

Keywords: Conflicts of interest; Industry payments; Physician disclosures; Sunshine act; Surgeon payments.