Open Payments Data Analysis of U.S. Surgeons Receiving Industry General Payments from 2016 to 2020: Payment Disparities and COVID-19 Pandemic Impact
Hannah M. Nelson4, Snehal Jadhav3, Collin E. Dougherty1, Heng Jiang4, David W. Mercer2, Shinobu Watanabe-Galloway3, Joshua M. Mammen1, Juan A. Santamaria-Barria*1
1Department of Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, Omaha, NE; 2Department of Surgery, University of Nebraska Medical Center, Omaha, NE; 3Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE; 4College of Medicine, University of Nebraska Medical Center, Omaha, NE
Objective. The Centers for Medicare & Medicaid Open Payments Data (OPD) reports industry payments made to physicians related to drugs and medical devices. General payments are those not associated with research. We aimed to characterize general payments made to U.S. surgeons.
Methods. OPD data were queried for U.S. surgeons who received general payments from 2016 to 2020. Payments’ nature, amount, company, covered product, and location were collected. Surgeons’ demographics, specialty, and leadership roles in hospitals, societies, and editorial boards were evaluated.
Results. From 2016 to 2020, 44,700 U.S. surgeons were paid more than half a billion industry dollars: $535,425,543 in 1,440,850 general payments. The median payment was $29.18. The most frequent payments were for food & beverage (76.6%) and travel & 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 & 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 ($45,068,060; 8.4%), 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 91.1% of payments ($399,897,217), followed by drugs & biologicals ($33,945,300; 7.7%). 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 payments ($245,031,174; 45.8%), followed by thoracic ($167,806,514; 31.3%) and vascular surgery ($60,781,266; 11.4%). 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 appeared to receive the highest payments (mean, $76,381; NS, p = 0.14). 120 surgeons were paid >$500,000, of which 5 were 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 appeared to receive higher payments than women (means, $1,735,570 vs. $684,224), and NHW men appeared to receive 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. Due to COVID-19, 2020 experienced half the number of payments than the preceding 3 years.
Conclusions. Surgeons received substantial industry non-research payments. Highest paid recipients were men, and further work is warranted in assessing how race, gender, and leadership roles influence the nature of industry payments and surgical practice.
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