In the Journals

Number of industry payments to hospital lab directors suggests potential conflicts of interest

A significant number of cardiac catheterization and electrophysiology laboratory directors have notable financial relationships within the biomedical industry that could create conflicts of interest, according to study results published in JAMA Internal Medicine.

The results suggest that further efforts are needed to ensure that such payments do not affect physician decisions on medical devices and pharmaceutical therapies that could influence patient care, according to the researchers.

“Medical directors of cardiac catheterization (CC) and electrophysiology (EP) laboratories play an important role in the selection of devices and medications available within hospital procedural areas,” Amarnath Annapureddy, MD, of the Center for Outcomes Research and Evaluation at Yale School of Medicine, and colleagues wrote. “This may also influence the practice patterns of their colleagues. As such, payments made from industry to medical directors of CC and EP laboratories have the potential to create conflicts of interest (COIs).”

Researchers analyzed nonresearch payment data for CC and EP laboratory directors affiliated with the top 100 cardiovascular hospitals in the United States based on 2017 US News & World rankings. Payment information was collected from the Open Payments Program, which lists biomedical industry and group-purchasing organization payments to physicians and hospitals publicly on its website.

Payments made to CC and EP laboratory directors were characterized and compared with payments made to interventional cardiologists and electrophysiologists practicing in the same zip code and in other areas of the country.

Researchers found that in 2017, CC laboratory directors affiliated with the top 100 hospitals listed in US News & World Report received $1,416,232 and EP laboratory directors received $2,307,504 in payments from industry sources.

The median payments made to CC laboratory directors ($3,203) and EP laboratory directors ($10,521) was significantly higher than the median payments made to interventional cardiologists($1,064) and electrophysiologists ($2,900) within the same ZIP code. Payments to laboratory directors were also higher compared with payments made to interventional cardiologists ($883) and electrophysiologists ($2,267) in the rest of the country.

Almost one-third of CC laboratory directors and half of EP laboratory directors received payments more than $10,000, the amount defined as a significant conflict of interest by the National Academy of Medicine.

Researchers noted that that further research is needed to determine how industry payments to lab directors could influence clinical decisions in hospitals.

“Prior research has suggested that device and pharmaceutical companies target physicians in leadership roles, but it is not known whether the presence or magnitude of payments to laboratory directors actually affects care,” Annapureddy and colleagues wrote. “With continued concerns about rising health care costs, it is important to ensure that physician decisions regarding choice of devices and other pharmaceutical therapies be driven by clinical and cost-effectiveness, not industry influence.” – by Erin Michael

Disclosures: Annapureddy reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.

A significant number of cardiac catheterization and electrophysiology laboratory directors have notable financial relationships within the biomedical industry that could create conflicts of interest, according to study results published in JAMA Internal Medicine.

The results suggest that further efforts are needed to ensure that such payments do not affect physician decisions on medical devices and pharmaceutical therapies that could influence patient care, according to the researchers.

“Medical directors of cardiac catheterization (CC) and electrophysiology (EP) laboratories play an important role in the selection of devices and medications available within hospital procedural areas,” Amarnath Annapureddy, MD, of the Center for Outcomes Research and Evaluation at Yale School of Medicine, and colleagues wrote. “This may also influence the practice patterns of their colleagues. As such, payments made from industry to medical directors of CC and EP laboratories have the potential to create conflicts of interest (COIs).”

Researchers analyzed nonresearch payment data for CC and EP laboratory directors affiliated with the top 100 cardiovascular hospitals in the United States based on 2017 US News & World rankings. Payment information was collected from the Open Payments Program, which lists biomedical industry and group-purchasing organization payments to physicians and hospitals publicly on its website.

Payments made to CC and EP laboratory directors were characterized and compared with payments made to interventional cardiologists and electrophysiologists practicing in the same zip code and in other areas of the country.

Researchers found that in 2017, CC laboratory directors affiliated with the top 100 hospitals listed in US News & World Report received $1,416,232 and EP laboratory directors received $2,307,504 in payments from industry sources.

The median payments made to CC laboratory directors ($3,203) and EP laboratory directors ($10,521) was significantly higher than the median payments made to interventional cardiologists($1,064) and electrophysiologists ($2,900) within the same ZIP code. Payments to laboratory directors were also higher compared with payments made to interventional cardiologists ($883) and electrophysiologists ($2,267) in the rest of the country.

Almost one-third of CC laboratory directors and half of EP laboratory directors received payments more than $10,000, the amount defined as a significant conflict of interest by the National Academy of Medicine.

Researchers noted that that further research is needed to determine how industry payments to lab directors could influence clinical decisions in hospitals.

“Prior research has suggested that device and pharmaceutical companies target physicians in leadership roles, but it is not known whether the presence or magnitude of payments to laboratory directors actually affects care,” Annapureddy and colleagues wrote. “With continued concerns about rising health care costs, it is important to ensure that physician decisions regarding choice of devices and other pharmaceutical therapies be driven by clinical and cost-effectiveness, not industry influence.” – by Erin Michael

Disclosures: Annapureddy reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.