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Association of Device Industry Payments, Physician Supply, and Regional Utilization of Orthopedic and Cardiac
Sruthi L Muluk1, Grace A Lin2,3, Timothy S Anderson4,5,6
1University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Insights
Physician supply and industry payments correlate with increased use of knee arthroplasty (KA) and percutaneous coronary interventions (PCI). Higher payments for knee prosthetics showed a stronger link to KA utilization than for cardiac stents and PCI.
Area of Science:
- Health Services Research
- Medical Economics
- Public Health Policy
Background:
- Geographic variations in high-cost medical procedures like knee arthroplasty (KA) and percutaneous coronary interventions (PCI) are not solely explained by patient demographics.
- Physician supply and marketing payments from medical device manufacturers may influence procedure utilization rates.
Purpose of the Study:
- To investigate the association between the supply of procedural physicians, marketing payments from medical device companies, and the utilization of KA and PCI.
- To analyze these relationships within Hospital Referral Regions (HRRs) in the USA.
Main Methods:
- Cross-sectional analysis using 2018 data from the CMS Open Payments database and the CMS Provider Utilization and Payment database.
- Examined Medicare fee-for-service (FFS) beneficiaries and payments made to cardiologists and orthopedic surgeons.
- Adjusted utilization rates for beneficiary demographics.
Main Results:
- Increased supply of interventional cardiologists and orthopedic surgeons correlated with higher rates of PCI and KA, respectively.
- A $10,000 increase in gift payments from stent manufacturers was linked to a rise in PCI rates.
- A $10,000 increase in total payments from knee prosthetic manufacturers was associated with higher KA rates, with gift payments also showing a significant association.
Conclusions:
- Regional physician supply and industry payments are associated with increased utilization of PCI and KA among Medicare FFS beneficiaries.
- The association between payments and procedural utilization was more pronounced for knee arthroplasty, an elective procedure, compared to percutaneous coronary interventions, which can be emergent.
Background:
Geographic variation in high-cost medical procedure utilization in the USA is not fully explained by patient factors but may be influenced by the supply of procedural physicians and marketing payments.
Objective:
To examine the association between physician supply, medical device-related marketing payments to physicians, and utilization of knee arthroplasty (KA) and percutaneous coronary interventions (PCI) within hospital referral regions (HRRs).
Design:
Cross-sectional analysis of data from the 2018 CMS Open Payments database and procedural utilization data from the CMS Provider Utilization and Payment database.
Participants:
Medicare-participating procedural cardiologists and orthopedic surgeons.
Main Measures:
Regional rates of PCIs and KAs per 100,000 Medicare fee-for-service (FFS) beneficiaries were estimated after adjustment for beneficiary demographics.
Key Results:
Across 306 HRRs, there were 109,301 payments (value $17,554,728) to cardiologists for cardiac stents and 68,132 payments (value $40,492,126) to orthopedic surgeons for prosthetic knees. Among HRRs, one additional interventional cardiologist was associated with an increase of 12.9 (CI, 9.3-16.5) PCIs per 100,000 beneficiaries, and one additional orthopedic surgeon was associated with an increase of 20.6 (CI, 16.9-24.4) KAs per 100,000 beneficiaries. A $10,000 increase in gift payments from stent manufacturers was associated with an increase of 26.0 (CI, 5.1-46.9) PCIs per 100,000 beneficiaries, while total and service payments were not associated with greater regional PCI utilization. A $10,000 increase in total payments from knee prosthetic manufacturers was associated with an increase of 2.9 (CI, 1.4-4.5) KAs per 100,000 beneficiaries, while a similar increase in gift and service payments was associated with an increase of 14.5 (CI, 5.0-24.1) and 3.4 (CI, 1.6-5.2) KAs, respectively.
Conclusions:
Among Medicare FFS beneficiaries, regional supply of physicians and receipt of industry payments were associated with greater use of PCIs and KAs. Relationships between payments and procedural utilization were more consistent for KAs, a largely elective procedure, compared to PCIs, which may be elective or emergent.
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