Top Cath and EP Lab Directors Receiving 'Notable' Industry Dollars

Debra L Beck

June 26, 2019

Nearly one-third of catheterization laboratory directors and almost one-half of electrophysiology (EP) laboratory directors at top US hospitals received more than $10,000 in payments from industry sources in 2017.

This analysis of the Open Payments Program (OPP) database was conducted by researchers at the Yale School of Medicine in New Haven, Connecticut, and published as a Research Letter in JAMA Internal Medicine on June 17.

OPP is a provision of the Affordable Care Act created to improve transparency in biomedical research and physician prescribing practices. The website is managed by the Centers for Medicare and Medicaid Services and reveals transactions across 13 predefined categories between industry entities and physician and hospital collaborators.

"Efforts to prevent the appearance of undue influence by the biomedical industry are warranted to avoid undermining public trust in the medical community," write the researchers, led by Amarnath Annapureddy, MD, Center for Outcomes Research and Evaluation, Yale. "At a minimum, physicians who receive payments should be prepared to justify their interactions with industry and explain their approach to mitigating COIs."

Medical directors of catheterization and EP laboratories often play an important role in determining which devices are stocked and used in their labs. As such, industry support may have the potential to unduly influence these decisions, suggest Annapureddy and colleagues.

Their study looked at the Top 100 US hospitals for Cardiology and Heart Surgery as rated by the 2017 US News & World Report rankings. They characterized total payments made to lab directors at these hospitals, along with payments made to interventional cardiologists (ICs) and electrophysiologists who practice in the same zip code, and those who practice in other areas of the country.

For the cath-lab directors, the median payment per physician for the year 2017 was $3203, the mean was $14,305, and 31% received $10,000 or more.

According to the National Academy of Medicine (previously called the Institute of Medicine), payments of $10,000 or more are considered significant COI.

Most of the payments were classified as either "consulting fees" (35%) or "compensation for services" (24%), which was defined as "payments made to physicians for speaking, training, and education engagements that are not for CME, such as discussing drugs or devices with other physicians at a restaurant," note Annapureddy et al. Nineteen percent of payments were for food and lodging and 5% were for speaking at a CME event.

These breakdowns were fairly similar for nondirector ICs in the same zip code at the Top 100 cardiology hospitals, except the median and mean payments in that group were lower in 2017, at $1064 and $10,077, respectively. Only 18% received $10,000 or more for the year.

The findings were also similar for EP lab directors, although the dollar amounts were all higher. For directors at the Top 100 cardiology hospitals, the median and mean payments per physician were $10,521 and $24,036, respectively, and 51% topped the $10,000 mark.

For the nondirector EPs in the same areas, the median and mean were $2900 and $17,583, respectively, and 30% had annual payments that exceeded $10,000.

"Going forward it would be important to understand whether biomedical industry payments to laboratory directors influences clinical decision-making within the procedural areas they oversee," Annapureddy writes.

The researchers concede that there is not clear evidence that the presence or magnitude of payments made to cath and EP lab directors affects care.

"These companies give money because they get a return on investment, so I would have to conclude that they're getting a return on these payments," Rita F. Redberg, MD, told theheart.org | Medscape Cardiology.

Redberg is the editor of JAMA Internal Medicine and a cardiologist at the University of California, San Francisco. She authored an Editor's Note that accompanied the Research Letter.

For her part, she thinks professional societies should prohibit doctors from relationships with industry when they make purchasing decisions for their hospitals. "I assume that everyone wants to do the right thing, but there's also a lack of transparency about the prices of these devices, how device choices are made…, even the choice of whether or not to use a device or do an intervention," she said.

Interventional cardiologist Adam C. Salisbury, MD, MSc, Saint Luke's Mid-America Heart Institute, Kansas City, Missouri, suggested in an interview that the differences seen in this study in payment amounts may be a result of cath- and EP-lab directors having more opportunity for industry sponsorship because of their stature, rather than their ability to influence usage.

"They tend to be very established and senior and are often viewed as thought leaders, so I would say they certainly have more opportunity than your average practicing IC to do these talks and participate in industry-sponsored educational efforts," he said. "Furthermore, most academic institutions require that directors declare their industry relationships, and these relationships are well known by hospital administration."

Also, Salisbury suggested the findings may not be as damning as they first seem, given how some of the payments are aggregated on the OPP.

"What they call 'payment for services' in the article is defined as education that is not for CME, 'such as dinners,' but these could also reflect non-CME educational courses. Our hospital, for example, is a very active center for chronic total occlusion coronary angioplasty, and we often host physician training courses that include didactic sessions, case reviews, and observation of cases," he said.

"These educational efforts are not for CME, and are sponsored by industry. At our hospital, these funds are used to support a complex PCI fellowship and to fund research in this space, but the monies are attributed to the physicians leading these programs using the methodology that appears to have been used in this study. Cath-lab directors frequently participate in these programs," said Salisbury.

Annapureddy and Redberg reported that they have no relationships relevant to this report to disclose. Salisbury reported receiving institutional research grant support from Boston Scientific and Gilead, and consulting fees from Medtronic.

JAMA Intern Med. Published online June 17, 2019. Research Letter, Editor's Note

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