Impact of US Industry Payment Disclosure Laws on Payments to Surgeons: A Natural Experiment
As of August 2013, the Affordable Care Act of 2010 established the Open Payments program also known as the Physician Payment Sunshine Act. Pharmaceutical and medical device manufacturers had to start reporting nearly all payments to physicians and teaching hospitals to the Centers for Medicare & Medicaid Services (CMS). The goal of this legislation was to minimize the perceived undue influence of industry over the medical profession. Several reports, articles, and books raised concerns that the primary goals of medicine, defined as improving health by providing beneficial care to patients, conducting valid research, and offering excellent medical education, were in danger of being compromised by the undue pursuit of financial gain, academic honors, or other secondary interests posed by conflicts of interest.
One study that looked at payouts to ObGyns who were trained in pelvic medicine and reconstructive surgery found that median total payments have decreased each year following the legislation while yearly research payments have increased.
Another recent study took advantage of a legal settlement between the Department of Justice and companies that manufacture hip and knee implants (2007). Due to the timing of the settlement, orthopedic surgeons became a specialty where mandatory disclosure of any payment from industry was required prior to the Sunshine Act taking effect. In a natural experiment, i.e. an empirical or observational study where the control and experimental variables of interest are influenced by nature or factors outside of the researchers’ control and not artificially manipulated by researchers, the authors compared orthopedic surgeons with non-orthopedic surgeons from 2014 to 2017 (post enactment of the Sunshine Act). They hypothesized that if the Sunshine Act impacted payments, orthopedic surgeons would already have felt the impact on payments from industry prior to the Sunshine Act. Therefore, following the Sunshine Act, non-orthopedic physicians would see a greater drop in their payments following their initial exposure to the legislation. The hypothesis held true and orthopedic surgeons did have a lower number and amount of payments received from industry when compared to non-orthopedic surgeons (predominantly in the form of food and beverages). However, research payments remained unchanged. These results suggest that the potential for undue influence on prescribing medication and professional behavior may be declining but research dollars have generally remained stable.
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