Dive Brief:

• Patients were more likely to receive an implantable cardioverter defibrillator or cardiac resynchronization therapy-defibrillator from the manufacturer that made the largest payment to their physician, according to findings in an original investigation published Tuesday in JAMA.
• The study tracked ICDs and CRT-Ds from four manufacturers implanted in 145,900 patients over a three-year period, concluding that between 38.5% and 54.7% of patients received devices from companies that had provided physicians with the largest payments. The study did not name the manufacturers, but some of the largest in the market include Abbott (via its acquisition of St. Jude Medical), Medtronic and Boston Scientific.
• In a related piece of research published in JAMA, Swedish researchers looking at payment trends to U.S. physicians found a decrease in the number receiving at least one payment from industry, from 52.2% in 2014 to 45% in 2018. Physicians receiving higher-value total payments continued to receive similar or greater amounts, suggesting an industry strategy of concentrating payment where a greater return on investment is anticipated, according to the research. 

Dive Insight:

The JAMA research leverages data now publicly available thanks to the Physician Payments Sunshine Act, a part of the Affordable Care Act, that requires medical product manufacturers to disclose to CMS information on financial relationships with clinicians. Such forms of payment range from free meals and research funding to consulting and speaker fees.

The ICD study by researchers affiliated with the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital examines the connection between the device industry and physician payments, and subsequent effects on device selection, quality of care and clinical outcomes in patients receiving their first ICD implant.

Despite concerns over potential bias among clinicians who receive training or research funding from a manufacturer, the researchers said most clinicians are unconvinced industry payments influence their practice patterns. However, past studies have consistently found that even small-value transactions may be linked to differences in prescribing patterns, the researchers said.

The study scrutinized data from 2016 through 2018 found in the National Cardiovascular Data Registry ICD Registry, linked with the Open Payments Program’s data. Devices were implanted by 4,435 physicians at 1,763 facilities. Of these physicians, 94% received payments from device manufacturers, with a median payment of $1,211 and top payment of $323,559.

In the subgroup of patients whose physicians received more than $25,000 annually, 51.1% to 59.5% received an ICD or CRT-D device from the manufacturer that provided the largest payment. Patients were substantially more likely to receive an ICD or CRT-D made by the manufacturer that provided the highest total payment than were patients of physicians who received no payment, the study found.

The analysis found statistically significant differences in the use of CRT-D among eligible patients, with higher rates of CRT-D use among physicians receiving high-value payments.

Quality of care, however, did not appear affected by whether a physician received a payment from a manufacturer. Rates of in-hospital procedural complications or death did not vary by presence or total value of physician payments, the study said.

"To our knowledge, the current study is likely the first to evaluate the association between payments to physicians and quality of care," researchers wrote, adding, "additional studies assessing the association between receipt of payments and longer-term outcomes may be warranted."