Distribution of Industry Payments among Medical Directors of Catheterization & Electrophysiology Laboratories from the Top 100 US Hospitals

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Distribution of Industry Payments among
Medical Directors of Catheterization and
Electrophysiology Laboratories from the
Top 100 US Hospitals
Amarnath Annapureddy, MD1; Prasanna Sengodan, MD2
Shiwani Mahajan, MBBS1; Tulasi Annapureddy, MD3
Karthik Murugiah, MD1 Nihar R. Desai, MD, MPH1;
Jeptha P. Curtis, MD1
Courtesy: JAMA Intern Med. published online
June 17, 2019. doi: 10.1001/jamainternmed.2018.8775

Medical directors of cardiac catheterization (CC) and electrophysiology (EP) laboratories play an important role in the selection of devices and medications available within hospital procedural areas. This may also influence the practice patterns of their colleagues. As such, payments made from industry to medical directors of CC and EP laboratories have the potential to create conflicts of interest (COIs). The National Academy of Medicine (previously the Institute of Medicine) defines a COI as an event where an individual or institution has a secondary interest that creates a risk of undue influence on decisions or actions affecting a primary interest, and notes that any payment of $10,000 or more constitutes a significant COI. However, to our knowledge, the extent and nature of payments to laboratory directors from top-ranking institutions has not been described previously.

The Open Payments Program (OPP) mandated that biomedical industry and group-purchasing organizations report payments to physicians and hospitals. Since August 2013, information about eligible payments has been made publicly available through the OPP website.1 We used OPP data to characterize patterns of industry payments to laboratory directors at premier cardiovascular hospitals in the United States.

Methods

We analyzed non research payment data for 2017.2 We identified CC and EP laboratory directors for the top 100 US cardiovascular hospitals defined by the 2017 US News & World Report rankings.3 We characterized the total payments made to CC and EP laboratory directors, and compared their payments with payments made to interventional cardiologists (IC) and electro physiologists (EPs) who practiced in the same zip codes, as well as to IC and EP physicians practicing in other areas of the country. We further characterized types of financial transactions using 13 OPP-defined categories: (1) compensation for services, (2) consulting fees, (3) food and beverage, (4) travel and lodging, (5) speaking at accredited and non- accredited continuing medical education events, (6) honoraria, (7) grants, (8) education, (9) ownership or investment interest, (10) charitable contribution, (11) entertainment, (12) royalty, and (13) gifts.2 For CC and EP directors of the top 100 hospitals, we assessed the correlation of industry payments with hospitals US News and World Report  cardiovascular summary scores and laboratory directors Hirsch index, a well-validated measure of an the scientific productivity of a particular author.

This study was exempt from institutional review board approval owing to the use of publicly available data that were unrelated to patients or concerns of identifiability. Stata, version 15.1 (StataCorp, LP) was used for statistical analysis; P.05 (2-sided) was considered significant.

Results

For 2017, directors of CC and EP laboratories affiliated with the top 100 hospitals based on US News & World Report rankings3 received $1416232 and $2307504 from industry, respectively Among the 195 laboratory directors included in the study, 7 IC directors and 4 EP directors received no payments in 2017. Median (interquartile range [IQR]) payments to directors of CC laboratories were significantly higher compared with ICs ($3203 [$388-$14156] vs $1064 [$206-$4104]), and payments to directors of EP laboratories were significantly higher compared with EP physicians practicing in the same zip codes ($10521 [$1159-$35076] vs $2900 [$549-$13101]); payments for director of laboratories were also significantly higher than ICs ($883 [$285-$2307]) and EP physicians ($2267 [$622-$8377]) in the rest of the country. Nearly one-third of CC laboratory directors and nearly half of EP laboratory directors received payments of $10000 or more. Among the laboratory directors, more than one-third of payments were made for compensation for services such as speaking at dinner talks. There was variation in the types of payments to ICs and EPs, most notably in the categories of compensation for services and consulting fees. Electrophysiologists received 74% of their total payments from device manufacturers while ICs received 61% of their total payments from device manufacturers. The value of payments to laboratory directors from the top 100 hospitals poorly correlated with hospital score.

Discussion

Our study suggests that a large proportion of CC and EP laboratory directors have notable financial relationships with industry. To address the issue of COIs, both the Society for Cardiovascular Angiography and Interventions4 and the Heart Rhythm Society5 provided guidelines for interacting with industry, stating that physicians who serve on product review committees for their hospital disclose those relationships and recuse themselves from related decisions.4,5 Hospitals generally have policies in place to mitigate COIs, but it is not known how the content and enforcement of these policies may vary across hospitals. Efforts to prevent the appearance of undue influence by the biomedical industry are warranted to avoid undermining public trust in the medical community. At a minimum, physicians who receive payments should be prepared to justify their interactions with industry and explain their approach to mitigating COIs.

Limitations of the study: First, we used a systematic approach to identify laboratory directors but cannot exclude the possibility of misclassifications. Second, the data submitted to the OPP may have inaccuracies. However, we would anticipate that inaccuracies would not vary between laboratory directors and other clinicians.

Going forward, it will be important to understand whether biomedical industry payments to laboratory directors’ influences clinical decision-making within the procedural areas they oversee. Prior research has suggested that device and pharmaceutical companies target physicians in leadership roles, but it is not known whether the presence or magnitude of payments to laboratory directors actually affects care.6 With continued concerns about rising health care costs, it is important to ensure that physician decisions regarding choice of devices and other pharmaceutical therapies be driven by clinical and cost-effectiveness, not industry influence.

Accepted for Publication:  December 10, 2019.

Corresponding Author: Jeptha P. Curtis, MD, Associate Professor of Medicine, Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, Dana 3, 789 Howard Avenue, New Haven, CT 06520 ( This email address is being protected from spambots. You need JavaScript enabled to view it. ).

Published Online: June 17, 2019. doi:10.1001/jamainternmed.2018.8775

Note: Dr. A. Annapureddy had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

References

  1. Lo B, Field  MJ. Institute of Medicine Committee on Conflict of Interest in Medical Research. Washington, DC: Education and Practice; 2009:26.
  2. Centers for Medicare and & Medicaid Services. Open Payments Program. https://openpaymentsdata.cms.gov/. Accessed March 19, 2018.
  3. US News & World Report. Best Hospitals for Cardiology & Heart Surgery. https://health.usnews.com/best-hospitals/rankings/cardiology-and-heart-surgery. Accessed March 19, 2018.
  4. Naidu  SS, Aronow  HD, Box  LC,  et al.  SCAI expert consensus statement: 2016 best practices in the cardiac catheterization laboratory. Catheter Cardiovasc Interv. 2016;88(3):407-423. doi:10.1002/ccd.26551PubMedGoogle ScholarCrossref
  5. Lindsay  BD, Asirvatham  SJ, Curtis  AB,  et al.  Guidance for the Heart Rhythm Society pertaining to interactions with industry.  Heart Rhythm. 2011;8(7):e19-e23. doi:10.1016/j.hrthm.2011.05.011 PubMedGoogle ScholarCrossref
  6. Moynihan  R.  Key opinion leaders: independent experts or drug representatives in disguise?  BMJ. 2008;336(7658):1402-1403. doi:10.1136/bmj.39575.675787.651 PubMedGoogle ScholarCrossref
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