中心声誉和经验与先天性心脏病提供者的行业支付有关。
Center Reputation and Experience Relate to Industry Payments to Congenital Heart Disease Providers.
机构信息
Division of Pediatric Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York.
Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
出版信息
Ann Thorac Surg. 2021 Dec;112(6):2039-2045. doi: 10.1016/j.athoracsur.2020.10.012. Epub 2020 Nov 4.
BACKGROUND
The Physician Payments Sunshine Act was enacted to understand financial relationships with industry that might influence provider decisions. We investigated how industry payments within the congenital heart community relate to experience and reputation.
METHODS
Congenital cardiothoracic surgeons and pediatric cardiologists were identified from the Open Payments Database. All payments from 2013 through 2017 were matched to affiliated hospitals' U.S. News & World Report (USNWR) rankings, The Society of Thoracic Surgeons-Congenital Heart Surgery Public Reporting Star Ratings, and Optum Center of Excellence (COE) designation. Surgeon payments were linked to years since terminal training. Univariable analyses were conducted.
RESULTS
The median payment amount per surgeon ($71; interquartile range [IQR], $41-$99) was nearly double the median payment amount per cardiologist ($41; IQR, $18-$84; P < .05). For surgeons, median individual payment was 56% higher to payees at USNWR top 10 children's hospitals ($100; IQR, $28-$203) vs all others ($64; IQR, $23-$140; P < .001). For cardiologists, median individual payment was 26% higher to payees at USNWR top 10 children's hospitals ($73; IQR, $28-$197) vs all others ($58; IQR, $19-$140; P < .001). Findings were similar across The Society of Thoracic Surgeons-Congenital Heart Surgery star rankings and Optum Center of Excellence groups. By surgeon experience, surgeons 0 to 6 years posttraining (first quartile) received the highest number of median payments per surgeon (17 payments; IQR, 6.5-28 payments; P < .001). Surgeons 21 to 44 years posttraining (fourth quartile) received the lowest median individual payment ($51; IQR, $20-132; P < .001).
CONCLUSIONS
Industry payments vary by hospital reputation and provider experience. Such biases must be understood for self-governance and the delineation of conflict of interest policies that balance industry relationships with clinical innovation.
背景
《医师支付阳光法案》的颁布是为了了解可能影响提供者决策的行业财务关系。我们调查了先天性心脏领域的行业支付与经验和声誉的关系。
方法
从公开支付数据库中确定了先天性心胸外科医生和儿科心脏病专家。将 2013 年至 2017 年的所有款项与附属医院的《美国新闻与世界报道》（USNWR）排名、胸外科医师协会-先天性心脏病外科学术报告星级评级和 Optum 卓越中心（COE）指定进行匹配。将外科医生的付款与接受终末培训后的年限联系起来。进行了单变量分析。
结果
每位外科医生的中位数支付额（71 美元；四分位距 [IQR]，41-99 美元）几乎是每位心脏病专家中位数支付额（41 美元；IQR，18-84 美元；P <.05）的两倍。对于外科医生来说，向 USNWR 排名前 10 的儿童医院的付款人支付的中位数个人支付额高出 56%（100 美元；IQR，28-203 美元），而不是其他所有人（64 美元；IQR，23-140 美元；P <.001）。对于心脏病专家来说，向 USNWR 排名前 10 的儿童医院的付款人支付的中位数个人支付额高出 26%（73 美元；IQR，28-197 美元），而不是其他所有人（58 美元；IQR，19-140 美元；P <.001）。在胸外科医师协会-先天性心脏病手术星级评级和 Optum 卓越中心组中也发现了类似的结果。按外科医生经验计算，接受培训后 0 至 6 年（第一四分位数）的外科医生中位数支付额最高（17 笔付款；IQR，6.5-28 笔付款；P <.001）。接受培训后 21 至 44 年（第四四分位数）的外科医生中位数个人支付额最低（51 美元；IQR，20-132 美元；P <.001）。
结论
行业支付因医院声誉和提供者经验而异。为了自我监管和制定平衡行业关系与临床创新的利益冲突政策，必须了解这种偏见。
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