title: Orthopaedic Surgeons Receive the Most Industry Payments to Physicians but Large Disparities are Seen in Sunshine Act Data.
abstract: BACKGROUND
  Industry payments made to physicians by drug and device manufacturers or group purchasing organizations are now reported to the Centers for Medicare and Medicaid Services (CMS) as a part of the Physician Payments Sunshine Act. Initial reports from the program show that orthopaedic surgeons lead all physician specialties in total and average industry payments. However, before further discussion of these payments and their implications can take place, it remains to be seen whether these figures are a true reflection of the field of orthopaedic surgery in general, rather than the result of a few outlier physicians in the field. In addition, the nature and sources of these funds should be determined to better inform the national dialogue surrounding these payments.
  
  
  OBJECTIVE
  We asked: (1) How do industry payments to orthopaedic surgeons compare with payments to physicians and surgeons in other fields, in terms of median payments and the Gini index of disparity? (2) How much do payments to the highest-receiving orthopaedic surgeons contribute to total payments? (3) What kind of industry payments are orthopaedic surgeons receiving? (4) How much do the highest-paying manufacturers contribute to total payments to orthopaedic surgeons?
  
  
  METHODS
  We reviewed the most recent version of the CMS Sunshine Act Open Payments database released on December 19, 2014, containing data on payments made between August 1, 2013 and December 31, 2013. Data on total payments to individual physicians, physician specialty, the types of payments made, and the manufacturers making payments were reviewed. The Gini index of statistical dispersion was calculated for payments made to orthopaedic surgeons and compared with payments made to physicians and surgeons in all other medical specialties. A Gini index of 0 indicates complete equality of payments to everyone in the population, whereas an index of 1 indicates complete inequality, or all income going to one individual.
  
  
  RESULTS
  A total of 15,376 orthopaedic surgeons receiving payments during the 5-month period were identified, accounting for USD 109,846,482. The median payment to orthopaedic surgeons receiving payments was USD 121 (interquartile range, USD 34-619). The top 10% of orthopaedic surgeons receiving payments (1538 surgeons) received at least USD 4160 and accounted for 95% of total payments. Royalties and patent licenses accounted for 69% of all industry payments to orthopaedic surgeons.
  
  
  CONCLUSIONS
  Even as a relatively small specialty, orthopaedic surgeons received substantial payments from industry (more than USD 110 million) during the 5-month study period. Whether there is a true return of value from these payments remains to be seen; however, future ethical and policy discussions regarding industry payments to orthopaedic surgeons should take into account the large disparities in payments that are present and also the nature of the payments being made. It is possible that patients and policymakers may view industry payments to orthopaedic surgeons more positively in light of these new findings.
  
  
  METHODS
  Level III, Economic and Decision Analysis.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 800 Howard Ave, New Haven, CT, 06510, USA.
authors.forename: Andre M
authors.initials: AM
authors.lastname: Samuel
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Webb
authors.forename: Adam M
authors.initials: AM
authors.lastname: Lukasiewicz
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Bohl
authors.forename: Bryce A
authors.initials: BA
authors.lastname: Basques
authors.forename: Glenn S
authors.initials: GS
authors.lastname: Russo
authors.forename: Vinay K
authors.initials: VK
authors.lastname: Rathi
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Grauer
mesh_terms: D004345:Drug Industry / Q000191:economics; D066192:Manufacturing Industry / Q000191:economics; D008511:Medicine; D009983:Orthopedic Equipment; D009985:Orthopedics / Q000191:economics*; D058991:Patient Protection and Affordable Care Act / Q000331:legislation & jurisprudence; D012051:Reimbursement Mechanisms; D012189:Retrospective Studies; D014481:United States