Objectives To compare changes in the number and amount of payments received by orthopedic and non-orthopedic surgeons from industry between 2014 and 2017. Methods Using the Centers for Medicare and Medicaid Services (CMS) Open Payment database from 2014 to 2017, we conducted a retrospective cohort study of industry payments to surgeons, including general payments and research payments. Results Among orthopedic surgeons, the total number of general payments decreased from 248,698 in 2014 to 241,966 in 2017, but their total value increased from $97.1 million in 2014 to $110.2 million in 2017. Among non-orthopedic surgeons, the total number decreased from 604,884 in 2014 to 582,490 in 2017, while the total value remained stable at approximately $159 million. Between 2014 and 2017, there was a differential increase in the median number of general payments received by non-orthopedic when compared to orthopedic surgeons (incidence rate ratio, 1.09; 95% CI, 1.08–1.09; p < 0.001), but a differential decline in the median value of general payments (− 8.9%; 95% CI, − 9.5%, − 8.4%; p < 0.001). Findings were consistent when stratified by nature of payment. In contrast, between 2014 and 2017, there was neither a differential change in the median number nor median value of research payments received by non-orthopedics. Conclusion Examination of a natural experiment of prior public disclosure of payments to orthopedic surgeons suggests that the Physician Payment Sunshine Act was associated with an increase in the number, but a decline in the value, of general payments received by non-orthopedic surgeons, but not on research payments received.

中文翻译：

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美国行业支付披露法对外科医生支付的影响：自然实验

目的 比较 2014 年至 2017 年骨科和非骨科外科医生从行业收到的付款数量和金额的变化。方法使用医疗保险和医疗补助服务中心 (CMS) 开放付款数据库从 2014 年到 2017 年，我们进行了回顾性研究外科医生行业支付的队列研究，包括一般支付和研究支付。结果在骨科医生中，一般支付的总数从 2014 年的 248,698 减少到 2017 年的 241,966，但其总价值从 2014 年的 9710 万美元增加到 2017 年的 1.102 亿美元。在非骨科医生中，总数从 604,884 减少2014 年增加到 2017 年的 582,490，而总价值保持稳定在约 1.59 亿美元。2014 年至 2017 年间，与整形外科医生相比，非整形外科医生收到的一般性付款的中位数存在差异（发生率比，1.09；95% CI，1.08-1.09；p < 0.001），但中值下降差异一般支付（- 8.9%；95% CI，- 9.5%，- 8.4%；p < 0.001）。按付款性质分层时，结果是一致的。相比之下，在 2014 年至 2017 年期间，非骨科医师收到的研究付款的中位数和中位数均没有差异变化。结论 对先前公开披露向整形外科医生的付款的自然实验的检查表明，《医师付款阳光法案》与非整形外科医生收到的一般付款的数量增加但价值下降有关，