Industry Payments in Oral and Maxillofacial Surgery: A Review of 112,448 Payments From a National Disclosure Program

Facial plating industry payments: An analysis of the open payments database

Objective

To compare industry payments from facial plating companies to plastic surgery, oral and maxillofacial surgery (OMFS), and otolaryngology (OHNS).

Methods

The Open Payments Database was queried from 2016 to 2021 to identify all industry disbursements related to facial plating products from Stryker, Zimmer Biomet, Depuy Synthes Products, Acumed, and KLS Martin. Total dollars, number of payments, and specialists paid were compared between plastic surgery, OMFS, and OHNS. Funding was correlated to estimated case volume and number of licensed surgeons determined by literature review.

Results

From 2016 through 2021, OMFS received an average of $786,497 annually, followed by plastic surgery ($765,482), and OHNS ($184,484). On average, facial plating companies distributed 2256, 963, and 917 yearly payments to 699 oral and maxillofacial surgeons, 378 plastic surgeons, and 354 otolaryngologists, respectively. Total dollars, number of payments, and specialists paid were significantly different between specialties (p < .05). Facial trauma coverage is 39.6% by plastic surgery, 36.6% by OMFS, and 23.3% by OHNS. There are 7560 licensed oral and maxillofacial surgeons, 4948 plastic surgeons, and 11,778 otolaryngologists in the United States. Decreased payment to OHNS was more than could be accounted for by case volume alone.

Conclusions

The facial plating industry allocates more funding dollars to OMFS and plastic surgery compared to OHNS. OMFS receives the greatest number of payments to the most specialists compared to plastic surgery and OHNS. Engagement between OHNS and the facial plating industry is a potential area of growth in the future.Level of evidence: Level 4.

Industry Payments to Plastic Surgeons, 2013 to 2018: Who's Getting Paid?

BACKGROUND

The Physician Payments Sunshine Act of 2010 mandated that all industry payments to physicians be publicly disclosed. To date, industry support of plastic surgeons has not been longitudinally characterized. The authors seek to evaluate payment trends from 2013 to 2018 and characteristics across plastic surgeon recipients of industry payments.

METHODS

The authors cross-referenced those in the 2019 American Society of Plastic Surgeons member database with Centers for Medicare & Medicaid Services Open Payments database physician profile identification number indicating industry funds received within the study period. We categorized surgeons by years since American Board of Plastic Surgery certification, practice region, and academic affiliation.

RESULTS

A sum of $89,436,100 (247,614 payments) was received by 3855 plastic surgeons. The top 1 percent of earners (n = 39) by dollar amount received 52 percent of industry dollars to plastic surgeons; of these, nine (23 percent) were academic. Overall, 428 surgeons (11 percent) were academic and received comparable dollar amounts from industry as their nonacademic counterparts. Neither geographic location nor years of experience were independent predictors of payments received. The majority of individual transactions were for food and beverage, whereas the majority of industry dollars were typically for royalties or license.

CONCLUSIONS

Over half of all industry dollars transferred went to just 1 percent of American Society of Plastic Surgeons members receiving payments between 2013 and 2018. Considerable heterogeneity exists when accounting for payment subcategories.

Industry payments made to academic endodontists: Sex differences and other insights into financial relationships

BACKGROUND

Industry payments made to health care providers can create competing interests. The purpose of this study was to define the overall financial relationships between industry and academic endodontics faculty members, detail any variation in such payment data as related to individual faculty member characteristics and leadership position by institution type, and comment on the potential impacts from conflicts of interest (COIs) created by such relationships.

METHODS

The author identified and characterized academic endodontists from information on their institutional websites. The author obtained reported industry payments from 2013 through 2019 from the Centers for Medicare & Medicaid Services Open Payments database. The author also noted the distributions of academic endodontists and industry payments by institution, academic rank, sex, and residency program director position. The author subjected the data to descriptive and nonparametric analyses.

RESULTS

Of the 302 academic endodontists included, 240 (80%) accepted reported industry payments totaling $4,260,316.97. Overall, the median of total industry payments for all 302 faculty members was $217.89 (interquartile range [IQR], $34.06-$3,070.00). Among those accepting payments, the median amount was $382.80 (IQR, $110.40-$6,234.00). The top decile of paid academic endodontists received $3,669,291.47 in industry payments (86% of the total), with a median payment of $24,013 (IQR, $17,043-$91,190). Significant sex-associated industry payment differences were seen among the overall faculty and among those with the residency program director position.

CONCLUSIONS

Most academic endodontists accept industry payments. Significant sex differences exist in overall faculty member academic rank distribution, leadership role, and accepted median industry payment amounts. COI issues have the potential to arise among academic endodontists when such industry payments are accepted.

PRACTICAL IMPLICATIONS

Existing sex disparities in academic endodontics within the United States ideally should be acknowledged. COI issues can arise when academic faculty members accept industry payments. Public knowledge of these conflicts could negatively affect individual faculty members, their institutions, and related areas such as academic publishing. Appropriate faculty member COI disclosure, attestation, annual updates, and transparency are important mitigation measures.

Orthopaedic Foot and Ankle Surgeon Industry Compensation Reported by the Open Payments Database

Background. The current study aims to characterize and explore trends in Open Payments Database (OPD) payments reported to orthopaedic foot and ankle (F&A) surgeons. OPD payments are classified as General, Ownership, or Research. Methods. General, Ownership, and Research payments to orthopaedic F&A surgeons were characterized by total payment sum and number of transactions. The total payment was compared by category. Payments per surgeon were also assessed. Median payments for all orthopaedic F&A surgeons and the top 5% compensated were calculated and compared across the years. Medians were compared through Mann-Whitney U tests. Results. Over the period, industry paid over $39 million through 29,442 transactions to 802 orthopaedic F&A surgeons. The majority of this payment was General (64%), followed by Ownership (34%) and Research (2%). The median annual payments per orthopaedic F&A surgeon were compared to the 2014 median ($616): 2015 ($505; P = .191), 2016 ($868; P = .088), and 2017 ($336; P = .084). Over these years, the annual number of compensated orthopaedic F&A surgeons increased from 490 to 556. Averaged over 4 years, 91% of the total orthopaedic F&A payment was made to the top 5% of orthopaedic F&A surgeons. The median payment for this group increased from $177 000 (2014) to $192 000 (2017; P = .012). Conclusion. Though median payments to the top 5% of orthopaedic F&A surgeons increased, there was no overall change in median payment over four years for all compensated orthopaedic F&A surgeons. These findings shed insight into the orthopaedic F&A surgeon-industry relationship.Levels of Evidence: III, Retrospective Study.

Which Factors Affect the Completion and Publication of Dental Implant Trials?

PURPOSE

Clinical decision making in implant dentistry may be vulnerable to industry influence. The purpose of this study was to identify factors associated with the completion and publication of implant trials.

MATERIALS AND METHODS

This was a cross-sectional study of dental implant trials registered with ClinicalTrials.gov. The predictor variables were composed of a set of study characteristics including study design (investigational or observational), topic, sample size (≤50 or >50 participants), investigator specialty (periodontics, oral-maxillofacial surgery, prosthodontics, general/implantology, or other), study site (United States or international), and industry funding (yes or no). The outcome variables were time to study completion and time to publication. Reverse Kaplan-Meier analyses were used to determine time-to-event probabilities, and Cox proportional hazards models were used to identify factors associated with study completion and publication.

RESULTS

A total of 317 trials were included in the final sample. The median trial duration was 2.3 years, and the median time from completion to publication was 1.9 years. Compared with periodontist-led trials, oral and maxillofacial surgeon-led trials had greater success with publication (publication rate, 73.0% vs 54.4%; P = .01) but were less likely to be conducted in the United States (US site present, 8.8% vs 46.0%; P < .01). Trials that received industry funding were able to extend their operations by an average period of 1.2 years (P < .01). The projected trial completion rate at 5 years was 78.0%, and the projected publication rate 5 years after completion was 94.0%. Multivariate Cox regression showed that both industry-funded trials (hazard ratio, 0.66; P < .01) and pharmacologic studies (hazard ratio, 1.69; P = .02) were significantly associated with the completion rate. Among completed trials, neither industry sponsorship nor any other factor influenced the publication rate over time.

CONCLUSIONS

Trials that were industry funded had lower rates of completion but not publication. Future efforts should explore the reasons for research waste and improve US oral and maxillofacial surgeon involvement in clinical trial research.

Characteristics of Industry Payments to Ophthalmologists in the Open Payments Database

Importance

An increased awareness of the interactions between the medical industry and health care professionals may lead to lower health care costs and more effective health care practices.

Objective

To assess the characteristics of industry payments made to ophthalmologists between 2013 and 2017.

Design, Setting, and Participants

This analysis included data reported in the June 29, 2018, update of the Centers for Medicare & Medicaid Services Open Payments Database (OPD). The OPD contains public records of industry payments made to physicians and teaching hospitals from August 1, 2013, to December 31, 2017, as reported by the medical industry. All general or research payments distributed to US ophthalmologists and contained in the OPD were included in this study. Data are summarized by practitioner, manufacturer, payment category, and geographic location.

Main Outcomes and Measures

Main outcomes were the distribution, quantity, and value of payments made to ophthalmologists practicing in the United States or US territories. The financial characteristics of payment category, manufacturer, product, and location were also assessed.

Results

This analysis revealed that the OPD showed industry reporting a total of 20 943 ophthalmologists receiving 736 517 payments worth $543 679 603.53 (1.67% of all industry-reported funds in the OPD). The median payment value was $22.44. Most payments were for food and beverages (581 588 [78.96%]), whereas most funds were allocated toward research ($310 142 151.88 [57.05%]) and consulting fees ($73 565 327.71 [13.51%]). The median payout to each ophthalmologist was $637.75 (interquartile range, $167.33-$2065.54). California was the highest-grossing state, receiving $101 135 980.34 (18.60%) of all payments. Fifteen companies were responsible for 87.68% of all funds distributed ($476 719 470.11) and were mostly involved in the production of pharmaceutical agents (anti-vascular endothelial growth factor agents, glaucoma eyedrops, and ocular lubricants) and surgical devices (cataract and glaucoma).

Conclusions and Relevance

Although there is no way to know the veracity of these reports, the findings suggest the financial ophthalmologist-industry relationship is substantial. These relationships may be adding to health care costs and affecting the quality of care, although those associations were not evaluated in this study.