In November 2021, the Journal of the American Academy of Orthopaedic Surgeons (AAOS) published a research article on Orthopaedic Trauma Surgeons’ Financial Relationships with Industry: An Analysis of the Sunshine Act Reporting of Physician Open Payments from 2014 to 2019. Authors of the study include Nicholas Frane, DO; Matthew J. Partan, DO, PA; Peter B. White, DO, MS; Cesar Iturriaga, DO; John M. Tarazi, MD; Trinava Roy, BS; and Adam D. Bitterman, DO. In conducting the research, study authors performed a review of the Centers for Medicare and Medicaid Services (CMS) Open Payments Database for general industry payments made to orthopaedic trauma surgeons from 2014 to 2019. They then analyzed total payments and subtype payments for annual trends and adjusted all payments to 2019 dollars to adjust for inflation. Study authors hypothesized that increased transparency requirements would result in decreasing payments to surgeons across the study period.
The researchers found that from 2014 to 2019, 45,312 individual payments were given to orthopaedic trauma surgeons, totaling $41,376,397.85, with a mean of $919.54 per payment. Increased trends were noted for median annual payments, number of payments, and number of surgeons receiving payments. Median payments increased from $460.91 in 2014 to $1,284.06 in 2019.
Throughout the study period, the total number of payments increased to 60.3% and were distributed among a 14.7% increased number of surgeons. The total payment per surgeon positively correlated with years in the study period.
Payment subtypes that demonstrated increased median payments included consulting fees; education; entertainment, food, and beverage; and travel. Decreases in median payments were seen in faculty/speaker fees, royalties, and grant funding. However, the number of orthopaedic trauma surgeons receiving contributions from royalties and licensing increased from 14 in 2014 to 29 in 2019. Also, the total sum of royalties and licensing fees had large variations from year to year.
The highest sum payments were characterized as royalty or license fees making up $14,939,439.48 (36.1%), followed by consulting fees ($14,336,897.20 (34.6%)) and faculty or speaker fees ($5,472,012.01 (13.2%)).
Additionally, there were differences by region, with increasing trends in median payments in the midwest, south, and west, but not in the northeast. However, even though the northeast did not have an increasing trend in median payments, the northeast still had a 3.8-fold increase in median payments during the time period reviewed.
The study authors concluded “that the industry-physician relationship among orthopaedic trauma surgeons has expanded in the face of transparency, with median payments, total payment amount, and number of payments between 2014 and 2019 trending up,” especially among consulting fees, education, entertainment, food and beverage, and travel. The authors noted their belief that close relationships with industry can benefits patients and is responsible for “pivotal advancements in the field of orthopaedics and are essential for innovation.” They state that future research should aim to determine whether any of these financial relationships affect the cost of care to patients.