A Five-Year Analysis Of Physician-Industry Transactions In Plastic Surgery Using The Open Payments Database
Sumun Khetpal, BS, BA, Elbert Mets, BA, Neil Pathak, BS, John Persing, MD, Michael Alperovich, MD, MSc.
Yale University School of Medicine, New Haven, CT, USA.
PURPOSE: Industry financial relationships represent an important part in plastic surgery practice that has historically been difficult to study. As mandated by the Physician Payments Sunshine Act (PPSA) of 2013, the Open Payments Database (OPD) has increased transparency in physician-industry transactions. However, it remains unclear how industry payments to plastic surgeons have changed in light of this legislation. Therefore, this study aims to characterize trends in industry payments since passage of this legislation.
METHODS: Using the OPD, industry payments to plastic surgeons from 2014 to 2018 were examined. Median payments in 2015-2018 were compared to those from 2014 for all plastic surgeons, as well as for the top 5% of highest-grossing surgeons and the remaining 95% of surgeons. Payments were further characterized by recipient's census region (e.g., Northeast) and type of payment (e.g., education).
RESULTS: The median general payment to plastic surgeons increased from $236 in 2014 to $327 in 2018 (p < 0.001). The distribution of general payments was heavily weighted towards the top 5% of highest grossing plastic surgeons, with this subset of surgeons receiving over 80% of payment volume. Despite this group receiving the bulk of industry payments, no significant increase in the median payment to the top 5% of compensated surgeons was seen from 2014 to 2018. However, the remaining 95% of compensated surgeons saw significant increases in median general payments from $222 in 2014 to $294 in 2018 (p < 0.001).
Payments were further analyzed by census region. Surgeons in the South received the greatest number of payments across all five years studied. Considering payment trends within each region, there were significant increases in median general payments in the West, South, and Midwest, but not the Northeast, where there were notable decreases (p < 0.001).
Payment type and company type were also evaluated. Food and beverage represented 82% of all payments, but only accounted for 10% of total payment volume. On average, the twenty companies who paid plastic surgeons the most accounted for 94% of total payment volume, the top 10 companies for 81%, and the top 5 companies for 64%.
CONCLUSION: With the increased transparency of industry-to-physician payments brought about by the PPSA, industry payments to plastic surgeons were expected to decrease in value and volume. Instead, this study identifies that while the top 5% of compensated plastic surgeons have not seen increases in median payments, the remaining 95% saw significant increases from 2014 to 2018. This finding raises questions about the continued influence of physician-industry relationships on clinical practice in spite of legislation aimed at illuminating these arrangements.
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