The Impact of the Sunshine Act Open Payments Database on Industry Financial Relationships in Plastic Surgery

Background: The Sunshine Act Open Payments Database (OPD) was enacted to increase the transparency of financial relationships between health care providers and drug/device manufacturers, given the strong evidence that exists to indicate that these relationships influence clinical practice. However, the actual impact of this legislation remains a subject of debate. The objective of this study was to determine if and how the practice patterns of plastic surgeons changed following public reporting of these relationships.

Methods: A review of the OPD was performed from 2013 to 2014. This data was analyzed with respect to types and values of payments, as well as characteristics of plastic surgeons and companies, and compared between 2013 (the initial reporting year) and 2014.

Results: A total of 21,217 and 19,212 payments in 2013 and 2014 were reviewed, respectively. The total value of payments decreased by -21.14% from $9,102,196 to $7,177,763, although the average payment remained similar ($429 versus $373, respectively; p=0.44), as did the number of payments per plastic surgeon (5.1 versus 5.0, respectively; p=1.00). A significant decrease in the number of plastic surgeons receiving payments was observed (from 4,125 to 3,796; p<0.001). Compared to 2013, in 2014 there was a relative decrease in the proportion of payments related to speaker fees, with a concomitant increase in those related to consulting fees and royalties, although these changes were not statistically significant. Similarly, a decrease in the proportion of payments made to academic plastic surgeons was observed but not significant (from 9.8% to 9.1%; p=0.64). The number of companies involved in industry financial relationships with plastic surgeons remained essentially unchanged (223 versus 203, respectively; p=1.00).

Conclusions: Implementation of the Sunshine Act was associated with a significant decrease in the number of plastic surgeons involved in industry financial relationships, with an associated reduction in total dollars related to payments, and impacted academic and private plastic surgeons similarly. The system of public reporting within the OPD may be an effective means to reduce the influence of industry in plastic surgery.