Show Me the Money: Comparing Industry Payments to Physicians and Advanced Practice Clinicians Across Specialties in the USA

Abstract

With the inclusion of Advanced Practice Clinicians (APCs) in the Centers for Medicare and Medicaid Services (CMS) Open Payments program in 2021, alongside physicians, a more comprehensive understanding of industry payments across healthcare provider categories has become essential. The Sunshine Act, part of the 2010 Affordable Care Act, requires the disclosure of financial relationships between healthcare providers and industry to enhance transparency and address potential conflicts of interest. This study examines long-term trends in the CMS general payments database, categorizing physicians into surgical, medical, or other specialties and distinguishing between surgical and medical APCs. Our thirteen-year analysis highlights distinct payment patterns and variations among provider types. We compared distributions among surgical, medical, and other physicians, along with surgical and medical APCs. As a snapshot of trends, in 2023, surgical physicians received the highest average payment ($635.49), followed by other physicians ($221.95), medical physicians ($138.40), surgical APCs ($73.30), and medical APCs ($41.64). Food and beverage payments were the most common across all providers and made up the greatest value for medical and surgical APCs at 56% and 41% of their total payments respectively. The predominant nature of payments varied among specialties: compensation for speaking at medical education programs dominated for medical and other physicians, constituting 35% and 37% of their total payments in 2023, respectively. Conversely, surgical physicians saw the greatest value from royalties and licenses, accounting for 54% of their total payments. These financial interactions raise ethical and socio-political concerns, particularly around conflicts of interest and transparency in healthcare. As APCs take on a larger role in patient care, the influence of industry payments on their practice warrants scrutiny to maintain public trust. This study highlights the need for ethics support models and evaluation systems that account for the socio-political dimensions of healthcare, ensuring integrity in both practice and policy.

With the inclusion of Advanced Practice Clinicians (APCs) in the Centers for Medicare and Medicaid Services (CMS) Open Payments program in 2021, alongside physicians, a more comprehensive understanding of industry payments across healthcare provider categories has become essential. The Sunshine Act, part of the 2010 Affordable Care Act, requires the disclosure of financial relationships between healthcare providers and industry to enhance transparency and address potential conflicts of interest. This study examines long-term trends in the CMS general payments database, categorizing physicians into surgical, medical, or other specialties and distinguishing between surgical and medical APCs. Our thirteen-year analysis highlights distinct payment patterns and variations among provider types. We compared distributions among surgical, medical, and other physicians, along with surgical and medical APCs. As a snapshot of trends, in 2023, surgical physicians received the highest average payment ($635.49), followed by other physicians ($221.95), medical physicians ($138.40), surgical APCs ($73.30), and medical APCs ($41.64). Food and beverage payments were the most common across all providers and made up the greatest value for medical and surgical APCs at 56% and 41% of their total payments respectively. The predominant nature of payments varied among specialties: compensation for speaking at medical education programs dominated for medical and other physicians, constituting 35% and 37% of their total payments in 2023, respectively. Conversely, surgical physicians saw the greatest value from royalties and licenses, accounting for 54% of their total payments. These financial interactions raise ethical and socio-political concerns, particularly around conflicts of interest and transparency in healthcare. As APCs take on a larger role in patient care, the influence of industry payments on their practice warrants scrutiny to maintain public trust. This study highlights the need for ethics support models and evaluation systems that account for the socio-political dimensions of healthcare, ensuring integrity in both practice and policy.