130 - Discrepancies in Spine Surgeon Conflict-of-Interest Disclosures betwee...

#130 Discrepancies in Spine Surgeon Conflict-of-Interest Disclosures between a National Meeting and Physician Payment Listings on a Device Manufacturer Website

General Session: Quality of Spine Care

Presented by: R. Buerba

Author(s):

R.A. Buerba (1)
M. Fu (1)
J.N. Grauer (1)

(1) Yale University School of Medicine, Orthopaedics and Rehabilitation, New Haven, CT, USA

Abstract

Background: The Physician Payment Sunshine Act (PPSA) will require manufacturers of medical goods to report all payments to physicians worth >$10 on a public website by 2013. In preparation for the implementation of the PPSA, some orthopaedic device companies have begun to voluntarily report payments to their physician consultants. While these issues affect all areas of Orthopaedics, the field of spine surgery is particularly relevant given its extensive and well-known physician-industry relationships.

Previous studies have shown high rates of inconsistencies in physician disclosures at academic meetings, but none have looked at consistencies between physician reported disclosures and spine implant manufacturer reporting. We sought to evaluate this in the time-period preceding the implementation of the PPSA.

Methods: We compared the disclosures of participants at the 2011 North American Spine Society (NASS) annual meeting with the 2010 Medtronic physician payments. Medtronic was selected as this was a common source of financial support for NASS participants, and the time frame of disclosure mandated by NASS matched the reporting time frame on the Medtronic site. All data was drawn from publicly available sources.

Physicians common to both listings were identified. NASS required its participants to disclose all payments >$100 for the last calendar year, and any payments outside the calendar year related to the author's topic (disclosure statements indicated if payment(s) fell outside of calendar year). Medtronic listed physicians with total payments for the year >$5,000. Dollar ranges were summed to obtain each participant's total payment ranges. A discrepancy was noted whenever a participant's total NASS disclosure range did not overlap with his/her respective Medtronic website payment range. Fisher's exact test was used to compare disclosure discrepancy rates based on Medtronic payment size.

Results: The 2011 NASS meeting had 133/1100 (12.1%) participants disclose Medtronic. Their minimum, summed disclosed Medtronic payments totaled $19.3 million. Based on these participants' disclosures—according to Medtronic listing guidelines—44/75 (58.7%) should have been listed on the Medtronic website but were not; 1/19 (5.3%) should not have been listed but was. Potential discrepancy could not be determined for 39 participants (of these, 5/39 (12.8%) were listed on the Medtronic website). The definite discrepancy rate was 45/94 (47.9%) for valid comparisons.

The Medtronic 2010 Consultants website had 46/618 consultants (7.4%) participate in NASS 2011. Their minimum, summed Medtronic website payments totaled $34.4 million. Of these NASS participants, 25/46 (54.3%) disclosed a monetary amount in range with Medtronic's listing, while 21/46 (45.7%) had discrepancies [9/46 (19.6%) did not disclose earnings; 6/46 (13%) over-disclosed earnings; 6/46 (13%) under-disclosed earnings]. Those who received payments <$100,000 from Medtronic were more likely to have discrepancies in their NASS disclosure than those who received payments >$100,000 (P=0.009).

Conclusion: Discrepancy rates in monetary payments between what spine surgeons disclosed at NASS 2011 and what the Medtronic website reported were high. Possible explanations include surgeons' misunderstanding of disclosure instructions, confusion regarding whether payments given to institution/employers should be listed/disclosed, or reporting errors. This high discrepancy rate is concerning given the planned initiation of mandatory payment reporting following passage of the PPSA, as well as the increased public visibility of potential discrepancies. More uniform practices will certainly be necessary.