Industry payments to cardiologists remained largely stable in the first three years those payments were made publicly available, a new analysis found, with biomedical manufacturers distributing about $520 million to more than 30,000 U.S. cardiologists from 2014 to 2016.
The Sunshine Act was enacted in 2010 to increase the transparency of industry-physician relationships, noted Yale School of Medicine researcher Jeptha P. Curtis, MD, and coauthors. The Open Payments Program (OPP) followed, and since August 2013, information about payments from the medical industry has been made available publicly on the OPP website.
“Among the 10 manufacturers that accounted for the majority of the total payments, only 2 manufacturers significantly decreased the value of payments to physicians over the 3 years of the study, whereas the value of payments from the remaining 8 manufacturers was largely unchanged,” Curtis and colleagues wrote in Circulation: Cardiovascular Quality and Outcomes. “Nevertheless, these findings only reflect 3 years of availability of the OPP data, and it may take several years for the full impact of the Sunshine Act on physician and manufacturer behavior to become apparent.”
Curtis’ group presented preliminary research at the recent American Heart Association Scientific Sessions demonstrating that physicians with financial relationships to biomedical manufacturers were up to 12 times more likely to use an implantable cardioverter-defibrillator or cardiac resynchronization therapy-defibrillator from that company instead of another. However, patient outcomes didn’t appear to suffer based on whether the implanting physician had received payments from industry or not.
“I don’t think there’s anything inherently wrong about relationships between physicians and the device industry, but I do think we really need to tread carefully in that space,” Curtis told Cardiovascular Business in an interview about those studies. “The potential for the appearance of conflicts of interest is really significant and has the potential to undermine the faith that patients put in physicians.”
The newly published analysis revealed that a select minority of physicians and companies account for the majority of the payments. Only 3.5 percent of cardiologists with industry financial ties—or 1,067 people—received more than $100,000 over the three-year study period, but those doctors hauled in almost two-thirds of all payments.
Likewise, 10 manufacturers, out of 747 who made payments to physicians, dished out 60 percent of the money. Those companies provided $312 million in compensation during those three years.
For the well-compensated cardiologists, 54 percent of the payments were for speaking/promotional talks, 18 percent were for consulting fees and 12 percent were for ownership stakes.
“These findings suggest that the biomedical industry maintains deeper relationships with a relatively small group of cardiologists and that these relationships are consistent from year to year,” wrote Curtis, who holds equity interest in medical manufacturer Medtronic, and colleagues.
Manufacturers often target physicians they believe to be “thought leaders” who can influence the practice patterns of their colleagues, the authors said.
“In fact, there are firms dedicated to not only identifying key opinion leaders but also offering web services to keep track of opinion leaders and provide metrics on returns on their investment,” they wrote.
Curtis and colleagues said further research is needed to better understand the impact financial relationships with industry have on clinical decision-making, and whether the type or amount of payment has an effect. Their work at AHA 2018—highlighted Nov. 13 in Cardiovascular Business—was a step in that direction and uncovered a dose-response relationship. Higher payments from a company to a physician were linked to a greater likelihood the cardiologist would implant that manufacturer’s device.
“Pursuing this line of investigation will be critical to truly realizing the goal of the Sunshine Act to increase transparency of physician interactions with industry,” the authors noted.