From the Journals

Many cardiac catheterization, electrophysiology lab directors receive big industry payments

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Lift the veil on medical device purchasing

Far too much about the purchasing of medical devices – and the costs passed to insurers and ultimately patients – is secretive and requires an overhaul, according to Rita F. Redberg, MD.

Noting that the results from the study by Annapureddy et al. found that nearly one-third of catheterization lab directors and one-half of electrophysiology lab directors receive more than $10,000 annually, she wrote that “the prevalence of financial relationships and the magnitude of the payments are of great concern.” Even picking up a meal can be influential, she added; imagine the impact of such a large payment.

What can be done? “Professional society guidelines should prohibit doctors with relationships with industry from participating in decisions about what devices their hospital chooses to purchase,” she stated, and patients should be made aware of relationships between doctors and device companies. More transparency, across the board, is necessary.

Dr. Redburg is a cardiologist at the University of California, San Francisco; she is interested in promoting high-value health care, which emphasizes delivering appropriate treatment while avoiding tests or therapies without known benefit. These comments are adapted from an editorial accompanying the article by Annapureddy et al. (JAMA Intern Med. 2019 Jun 17. doi:10.1001/jamainternmed.2018.8737). Dr. Redberg reported no conflicts of interest.



Many cardiac catheterization and electrophysiology laboratory directors receive significant payments from industry that could create conflicts of interest, according to a new study of payments to lab directors at top hospitals.

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“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,” Amarnath Annapureddy, MD, of the Yale School of Medicine, New Haven, Conn. and coauthors wrote in their study published in JAMA Internal Medicine.

Dr. Annapureddy and fellow researchers analyzed Open Payments Program data from 2017 to determine payments made to cardiac catheterization and electrophysiology laboratory directors the top 100 hospitals based on US News and World Report’s ranking. They compared those payments to payments made to local interventional cardiologists and electrophysiologists, along with payments to interventional cardiologists and electrophysiologists from across the country.

In 2017, the directors of the top cardiac catheterization and electrophysiology labs received $1,416,232 and $2,307,504 from industry, respectively. The median payments to cardiac catheterization lab directors were significantly higher ($3,203 [$388-$14,156]), compared with interventional cardiologists ($1,064 [$206-$4,104]). The results were similar comparing electrophysiology lab directors with electrophysiology physicians practicing in the same zip codes ($10,521 [$1,159-$35,076] versus $2,900 [$549-$13,101]).

Overall, nearly one-third of cardiac catheterization lab directors and nearly half of electrophysiology lab directors received payments of $10,000 or more, an amount the National Academy of Medicine noted as constituting “a significant conflict of interest.”

The coauthors acknowledged their study’s limitations, including the possibility that they misclassified some lab directors and the fact that Open Payments Program’s data may have been inaccurate. However, they also anticipated that “inaccuracies would not vary between laboratory directors and other clinicians.”

Dr. Nihar R. Desai reported receiving funding from the Centers for Medicare & Medicaid Services, financial support from Johnson & Johnson, and research support from the American College of Cardiology Foundation. Dr. Jeptha P. Curtis reported receiving salary support from the American College of Cardiology, funding from the Centers for Medicare & Medicaid Services, and equity interest in Medtronic. No other authors reported any relevant financial disclosures. No funding for the study was reported.

SOURCE: Annapureddy A et al. JAMA Intern Med. 2019 Jun 17. doi:10.1001/jamainternmed.2018.8775.

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