Background: Prior work has found associations between pharmaceutical company marketing of opioids to outpatient physicians and physicians prescribing opioids (1). This study aimed to address a gap in the literature by examining whether there is an association between hospitalists receiving funding from opioid manufacturers and hospitalists prescribing opioids on discharge.
Methods: Open Payments data from 2015-2020 was used to create a sample of physicians who received money from pharmaceutical companies related to opioid medications. This sample was merged with Medicare Part B claims data for the years 2015-2021 and narrowed to only physicians for whom >95% of their billing occurred in the inpatient setting and were identified with one of the following specialties: internal medicine, hospitalist, family practice, geriatric medicine, or general practice. Medicare Part D Prescriber Files were used to extract the percent of all medications prescribed each year which were for opioids per Medicare Part D clinician. This was merged with the sample to create a sample of hospitalists and their opioid prescribing rate on discharge as well as whether they had received any money from opioid manufacturers. Descriptive statistics were generated for per-year values. An analytic sample was then created to identify physicians who were a hospitalist in the year they received funding in addition to the subsequent year. This analytic sample was used for separate linear regression models (controlling for year, gender of provider, and geographic region of provider) with payment amount and number of payments as exposures, and the percent of medications prescribed on discharge which were for opioids in the subsequent year of receipt of funding as the outcome. Analyses were completed in Stata 19.5.
Results: 372 hospitalists were included in the analytic sample of physicians who were a hospitalist in the year they received funding as well as the subsequent year. Of hospitalists who did receive money compared to those who didn’t, 76.34% were male compared to 61.49% and 50.54% were in urban areas compared to 11.12%. The number of hospitalists receiving funding peaked in the year 2016 at 375 (1.01% of all hospitalists) with a median of $23.49, declining to 30 hospitalists (0.07% of all hospitalists) receiving funding in 2020 with a median amount of $23.64. The amount of money received by hospitalists in the 99th percentile of total funding increased over time from $360.45 in 2015 to $2750 in 2020. While total payment amount was not associated with opioid prescribing, the number of payments a hospitalist received did have a statistically significant association with the rate at which opioids were prescribed on discharge. For each one additional payment received by a hospitalist, the percentage of their prescriptions which were for opioids on discharge the subsequent year increased by 0.83%.
Conclusions: These results find that there is an association between the number of payments hospitalists receive from pharmaceutical manufacturers related to opioids and prescribing opioids on discharge the subsequent year. Most hospitalists receiving funding are male and practice in urban areas, and the proportion of hospitalists receiving funding is decreasing with time. Research should continue to examine industry financial ties to hospitalists and hospitalist clinical behaviors, while taking into consideration not just whether payment amount might be associated with physician behaviors but also discrete individual payment events.
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