Physician Payments from Industry Are Associated with Greater Medicare Part D Prescribing Costs
Physician Payments from Industry Are Associated with Greater Medicare Part D Prescribing Costs
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DOI：
10.1371/journal.pone.0155474
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发表时间：
2016-05-16
期刊：
影响因子：
3.7
通讯作者：
Perlis, Clifford S.
中科院分区：
文献类型：
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作者：
Perlis, Roy H.;Perlis, Clifford S.
背景美国《医师支付阳光法案》要求报告医师从药品、医疗器械和生物制剂制造商处收到的付款或有价物品。这些支付对医生处方的影响还没有在大规模的检查。MethodsWe链接公共医疗保险D部分处方数据和阳光法案的数据为2013年。医生支付的专科内进行了检查，然后使用回归模型与处方成本和模式的关联。模型进行了调整，潜在的医生水平的混杂功能，包括性别，地理区域，和实践size.ResultsAmong 725,169个人与医疗保险处方数据，341,644有记录的支付在patient数据（47.1%）。在所有接受资金的医生中，平均支付额为1750美元（SD 28336美元）;中位数为138美元（IQR 48 - 394美元）。在检查的12个专业中，观察到剂量-反应关系，其中更高的支付与每位患者更高的处方成本相关。在调整后的回归模型中，在付款收据的前五分之一与每例患者的处方成本增加相关，范围从27美元（普外科）到2931美元（神经科）。类似的协会观察到的比例品牌prescription.ConclusionsWhile分布和支付的金额在不同的医疗专业，为每一个检查的12个专业收到的付款与更大的处方成本，每名患者，和更大比例的品牌药物处方。我们无法推断因果关系，但针对那些获得最多报酬的医生的干预措施可能会为解决美国的处方成本提供机会。
BackgroundThe U.S. Physician Payments Sunshine Act mandates the reporting of payments or items of value received by physicians from drug, medical device, and biological agent manufacturers. The impact of these payments on physician prescribing has not been examined at large scale.MethodsWe linked public Medicare Part D prescribing data and Sunshine Act data for 2013. Physician payments were examined descriptively within specialties, and then for association with prescribing costs and patterns using regression models. Models were adjusted for potential physician-level confounding features, including sex, geographic region, and practice size.ResultsAmong 725,169 individuals with Medicare prescribing data, 341,644 had documented payments in the OPP data (47.1%). Among all physicians receiving funds, mean payment was $1750 (SD $28336); median was $138 (IQR $48-$394). Across the 12 specialties examined, a dose-response relationship was observed in which greater payments were associated with greater prescribing costs per patient. In adjusted regression models, being in the top quintile of payment receipt was associated with incremental prescribing cost per patient ranging from $27 (general surgery) to $2931 (neurology). Similar associations were observed with proportion of branded prescriptions written.ConclusionsWhile distribution and amount of payments differed widely across medical specialties, for each of the 12 specialties examined the receipt of payments was associated with greater prescribing costs per patient, and greater proportion of branded medication prescribing. We cannot infer a causal relationship, but interventions aimed at those physicians receiving the most payments may present an opportunity to address prescribing costs in the US.