Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
J Surg Res. 2019 Jan;233:41-49. doi: 10.1016/j.jss.2018.07.004. Epub 2018 Aug 16.
The Physician Payments Sunshine Act mandates the submission of payment records between medical providers and industry. We used the Open Payments Program database to compare industry payments to surgeons and nonsurgeons, as well as among surgical specialties, and to identify geographic distribution of payments.
We included all reported industry payments in the Centers for Medicare and Medicaid Services' Open Payments Program in the United States, 2014-2015. Multivariable regression fixed effects panel analysis of total payments was conducted among surgeons, adjusting for surgeon specialty, payor type, payment category, and state. A geographic heat map was created.
Of 2,097,150 subjects meeting criteria, 1,957,528 (45.66%) were physicians. The mean standard deviation (SD) payment overall was $232.64 ($6262.00), and the state with the highest mean (SD) payment was Vermont at $2691.61 ($11,508.40). Surgeons numbered 153,916 (7.86%). The specialty with the highest mean (SD) payment was orthopedic surgery at $2811.50 ($33,632.71, P < 0.001). Among 2,097,150 subjects meeting criteria, in multivariable regression fixed effects panel analysis, orthopedic compared to general surgeons were significantly likely to receive more industry payments (beta $1065.34 [95% CI $279.00-1851.00, P = 0.008), even controlling for payor, payment type, and state. Significant geographic disparities in payment were noted as 12 states received the top mean ($24.52-$500,000.00), leaving seven states with the lowest ($0.00-$12.56).
There are significant differences in industry payments to surgeons versus nonsurgeons and among surgical specialties, as well geographic distribution of payments. These data may prompt further investigation into trends and their causality and effects on research and practice.
《医师薪酬阳光法案》要求医疗服务提供者和行业提交支付记录。我们使用公开支付计划数据库比较了外科医生和非外科医生之间、以及外科专业之间的行业支付情况，并确定了支付的地理分布。
我们纳入了美国医疗保险和医疗补助服务中心公开支付计划中 2014-2015 年报告的所有行业支付。对符合条件的 2097150 名受试者进行了外科医生之间总支付的多变量回归固定效应面板分析，调整了外科医生专业、付款人类型、支付类别和州。创建了一个地理热图。
在符合条件的 2097150 名受试者中，有 1957528 名（45.66%）为医生。总体平均标准偏差（SD）支付为 232.64 美元（6262.00 美元），支付平均水平最高的州是佛蒙特州，为 2691.61 美元（11508.40 美元）。外科医生人数为 153916 人（7.86%）。支付平均水平最高的专业是骨科，为 2811.50 美元（33632.71 美元，P<0.001）。在符合条件的 2097150 名受试者中，多变量回归固定效应面板分析显示，与普通外科医生相比，骨科医生更有可能收到更多的行业支付（β 1065.34 美元[95%置信区间 279.00-1851.00，P=0.008]，即使控制了付款人、支付类型和州）。支付的显著地理差异表明，12 个州的平均支付额最高（24.52-500000.00 美元），而 7 个州的平均支付额最低（0.00-12.56 美元）。
外科医生与非外科医生之间、以及外科专业之间的行业支付存在显著差异，支付的地理分布也存在显著差异。这些数据可能会促使人们进一步调查趋势及其对研究和实践的影响。
