Medical Device Industry Payments and Utilization of Corresponding Devices

Importance: Financial relationships between physicians and industry are common, yet the association between device industry payments and device utilization across specialties is not well characterized. Objective: To evaluate the association between device industry payments to physicians and device utilization across multiple specialties. Design, Setting, and Participants: This cross-sectional study with a repeated-measures design linked publicly available industry general payments data from the Centers for Medicare & Medicaid Services Open Payments Program (2015 to 2023) with a nationally representative 20% sample of Medicare fee-for-service claims. The study included physicians who performed device-associated procedures identifiable using distinct Current Procedural Terminology or Healthcare Common Procedure Coding System codes. Exposures: Annual physician-level general payments from device manufacturers, categorized as $0, greater than $0 to $2500, greater than $2500 to $5000, greater than $5000 to $7500, greater than $7500 to $10 000, and greater than $10 000. Main Outcomes and Measures: The primary outcome was annual physician-level utilization of device-associated procedures, measured as procedure counts. Associations between payment categories and utilization were assessed using generalized estimating equations with Poisson regression models, adjusting for calendar year. Results: Among 12 devices, cumulative industry general payments were $136 671 793, and 518 166 device-associated procedures were performed between 2015 and 2023. Across devices, aggregate payments ranged from $759 572 to $67 318 185, and procedure volumes ranged from 2212 to 149 230. Higher payment categories were associated with greater procedure utilization for all devices except one. For example, compared with physicians receiving no payments, those receiving more than $10 000 for prostatic urethral lift had higher adjusted mean annual procedure counts (10.6 [95% CI, 8.27-13.57] procedures vs 4.37 [95% CI, 8.27-13.57] procedures; incidence rate ratio, 2.42; 95% CI, 1.89-3.12; P < .001). Similarly, for hypoglossal nerve stimulation, physicians receiving more than $10 000 had higher adjusted mean annual counts than those receiving no payments (5.09 [95% CI, 3.65-7.11] procedures vs 2.16 [95% CI, 2.01-2.32] procedures; incidence rate ratio, 2.36; 95% CI, 1.68-3.32; P < .001). Conclusions and Relevance: In this cross-sectional study of Medicare data, device-related industry payments to physicians were associated with higher utilization of corresponding devices across multiple specialties and procedures. These findings highlight the need for continued transparency and evaluation of financial relationships between physicians and device manufacturers.