Industry Payments to Cardiologists Totaled Over $1 Billion From 2014 to 2019

Vinay Kini, MD

Courtesy of Weill Cornell Medicine

A new report suggests cardiologists in the United States received 5.5 million industry payments totaling $1.1 billion from 2014 to 2019, extending prior research into how payment practices have changed since the introduction of the Open Payments Program (OPP).¹

The investigative team led by Vinay Kini, MD, Weill Cornell Medicine, cited an overall decline in the total value of payments, but noted the highly prevalent nature of industry payments to cardiologists, with approximately 70% of US cardiologists accepting payments for each year of study.

“We observed significant declines in the total value of payments and payment per cardiologist, but no changes in the number of cardiologists accepting payments or the total number of payments made,” investigators wrote.

Collaborations between industry and physicians often propel scientific discoveries, but indiscriminate financial relationships can lead to both bias and overutilization and patient care. The OPP was established to increase transparency on this matter, publishing data on industry-physician financial interactions.¹ Using the OPP, Kini and colleagues examined contemporary trends in the proportion and characteristics of cardiologists receiving general industry payments.

Together, the investigative team performed a retrospective, population-based cohort study of cardiologists practicing in the United States from 2014 to 2019. Text-matching of physician’s full names and zip codes were used to link the OPP database that contains physicians on industry payments with the National Plan and Provider Enumeration System database that contains physician’s National Provider Identified and specialty practice.

Investigators obtained data on general industry payments between January 2014 – December 2019, excluding 2020 due to the COVID-19 pandemic. Overall, the study reported the total value and number of payments made to cardiologists, the number of cardiologists receiving payments, and the average and median aggregate value of payments per cardiologist. Values were adjusted to the weighted average of the 2019 Consumer Price index.

The investigative team calculated the annual percent change in payments over the study period and used linear regression to assess for changes in payments over time. Moreover, the Gini Index was calculated to assess payment dispersion among cardiologists. The Gini Index ranges from 0 to 1, with an index of 0 suggesting that every person in the group received an equal number of payments and an index of 1 indicating that only 1 person received all the payments.

According to the analysis, between 2014 and 2019, cardiologists in the US received 5.5 million payments totaling over $1 billion. From 2014 - 2019, investigators found the total value of payments made to cardiologists and payment per cardiologist declined significantly. The annual percent change was –4.9% (95% confidence interval [CI], –5.8% to –4.0%; P <.001) and –5.2% (95% CI, –6.9% to –3.2%; P = .002), respectively. Investigators noted no significant change in the number of cardiologists receiving payments or the number of payments made to cardiologists.

For the $1.1 billion total payments made between 2014 - 2019, speaker fees ($444.5 million, 40.8%), consulting fees ($207,7 million, 19.0%), and food and beverage ($143.2 million, 13.1%) were the largest payment groups. Speaker fees declined significantly (P = .008) over the study period, but investigators found no significant change in consulting or food/beverage fees. Data showed the mean Gini index was 0.88 (95% CI, 0.87 - 0.89).

Investigators attributed the decline in speaker fees to an environment of increased transparency and greater scrutiny from the public and peers.

The analysis also revealed most cardiologists (n = 28,896, 76.0%) received smaller payments of <$10,000 per year, accounting for $61.4 million (5.6% of total payments). However, a small percentage of cardiologists (n = 110, 0.3%) were indicated to have received large payments of >$1 million per year, accounting for $268.3 million (24.6% of total payments).

Kini and colleagues suggested taking further steps to address financial conflicts of interest may ultimately prove beneficial in promoting public trust in cardiology.

“In conclusion, our study suggests that although there have been some changes in industry payments to cardiologists since the inception of OPP, further targeted measures that address financial conflicts of interest may be useful in continuing to promote integrity and public trust in cardiology practice,” investigators wrote.

References

1. Zhang R, Purkayastha S, Ying X, et al. Trends in Industry Payments to Cardiologists From 2014 to 2019 [published online ahead of print, 2023 Mar 17]. Circ Cardiovasc Qual Outcomes. 2023;e009820. doi:10.1161/CIRCOUTCOMES.122.009820