Association of State Legislation and Industry Compensation to Orthopaedic Residents: A 3-Year Review of the Centers for Medicare and Medicaid Services Open Payments Database

Abstract

Background: The Sunshine Act aims to increase the transparency of physicians receiving compensation from pharmaceutical and medical device companies. Nine states have supplementary legislation in addition to the Federal Sunshine Act. The purpose of this study is to assess the characteristics of financial compensation to orthopaedic residents on the Centers for Medicare and Medicaid Services (CMS) Open Payments Database in states with more restrictive regulations compared with those without additional restrictions. Methods: A complete list of accredited orthopaedic residency programs in the United States was compiled using the Accreditation Council for Graduate Medical Education and American Osteopathic Academy of Orthopedics websites. The website of each orthopaedic residency program was searched to compile a list of residents who attended their program from 2014 to 2016. The CMS Open Payments Database was used to search the residents identified for the corresponding years. All data available on the CMS Open Payments Database were recorded. Results: Over the 3-year period, 3,622 residents were identified from 151 programs. A total of 41% of the residents were reported as receiving compensation from the industry. The percent of residents reported from programs in less restrictive states was 45% versus 28% in more restrictive states (P < 0.001). Residents had a mean of 5.3 transactions per year in less restrictive states and 2.4 transactions per year in more restrictive states (P < 0.001). The mean compensation per resident reported was $2,730 for less restrictive sates versus $1,937 for more restrictive states (P < 0.001). Discussion: Overall, 41% of orthopaedic residents were reported on the CMS Open Payments Database with fewer transactions and less compensation going to residents in states with more restrictive legislature. Potential implications on resident education remain unknown.

Orthopaedic Trauma Surgeons' Financial Relationships With Industry: An Analysis of the Sunshine Act Reporting of Physician Open Payments From 2014 to 2019

“…Garstka et al 11 determined that industry payments were markedly different in particular states in comparison with others and suggested that state government regulation has played a role in this distribution. Similarly, Wills et al 34 did a study on orthopaedic surgery residents receiving industry payments, showing that residents in least restrictive states were more likely to receive payments than those in more restrictive states. We believe that additional research is needed to determine the factors contributing to the geographic distribution of reported industry payments.…”

Reverse and Anatomic Shoulder Arthroplasty Regional Usage and Open Payment Analysis Using the Centers for Medicare and Medicaid Services Database

“… 13 Industry relationships represent another means of surgeon financial compensation, which is often out of proportion to the small specialty size. 18 …”

“…This suggests that the type of medical training may also affect the implant utilization behavior of practicing surgeons. 18 The Orthopaedic Census Survey reported just over 30 000 allopathic orthopedists in the United States at the time of publication in 2018. 26 The American Osteopathic Academy of Orthopedics website reports over 1900 members, with 192 practicing in the Northeast, 422 practicing in the Midwest, 349 practicing in the South, and 201 practicing in the West.…”

“… 13 , 25 The disclosure of relationships between physicians and hospitals with industry is crucial to preventing conflicts of interest and allows closer examination of indirect compensation. 28 , 29 …”

Disparities Among Industry’s Highly Compensated Orthopaedic Surgeons

“…The CMS database lists the following categories for which payments are received: consulting fee, royalty and licensing, food and beverage expenditure, travel and lodging, educational speaker payments, noneducational speaker payments, education, grant, entertainment, and gifts. The method employed was comparable with those that have been used in previous CMS studies 16,17 .…”