How We Compiled The Dollars for Docs Hospital Data

By Ryann Grochowski Jones and Charles Ornstein

Our goal was to compare U.S. hospitals based on the percentage of their affiliated physicians who
receive payments of various sizes from pharmaceutical and medical device companies.

To do this, we used several databases.

The data we used

First, for information on industry payments to doctors, we turned to the federal government’s Open
Payments system. All companies are required to submit this data, which is then made public under the
Physician Payment Sunshine Act, a part of the 2010 Affordable Care Act. We used a file called “General
payments,” which includes categories like promotional speaking, consulting, meals, travel, gifts and
royalties. It does not include payments for research. The data we used covers calendar year 2014 and
includes records on 605,680 providers (doctors, dentists, chiropractors, podiatrists and optometrists).

Second, to determine which physicians practiced at which hospitals, we used Medicare’s Physician
Compare data, which includes up to five hospital affiliations for each physician. Because 2014 was the
only full year for which Open Payments data existed at the time of our analysis, we used archived
Physician Compare data, thus providing a snapshot of physicians’ hospital affiliations as of December
2014. This file includes records on 890,707 health providers, of which 600,348 had at least one hospital
affiliation listed. Note: This data does not include doctors who don’t participate in Medicare and those
who don’t admit many patients to the hospital.

For information about a hospital’s characteristics, including address and ownership, we relied on
Medicare’s Provider of Services file from 2014, as well as data from the American Hospital Association
Annual Survey. Our analysis included 4,815 hospitals. Of those, 2241 are included in our tool because
they had at least 50 affiliated physicians.

Finally, we accessed ratings assigned to selected teaching hospitals in 2014 by the American Medical
Student Association, which compiles a tool called the AMSA Scorecard. The group reviewed the conflict-
of-interest policies of 204 teaching hospitals and gave the hospitals either an A (the best grade), a B, a C
or an Incomplete because their policies were “insufficient for evaluation.” The 2014 data was no longer
available on AMSA’s website, so we accessed it via the Internet Archive.

Cleaning and combining the data

Combining these datasets involved many choices, as well as voluminous data cleaning.

Health care providers are assigned to hospitals either by self-reporting or on the basis of their Medicare
claims. The first hospital listed denoted the strongest affiliation. ProPublica shared the listed hospital
assignments in Physician Compare with several hospitals in an attempt to verify their accuracy.
After consulting with these hospitals, we made a decision that the best approach was to include only
each doctor’s primary hospital affiliation (variable name “Claims based hospital affiliation CCN 1” in the
Physician Compare file). The hospitals we consulted told us that the lower affiliations contained more
errors. We also made a decision to include only the top 100 medical specialties in both the Physician
Compare and Open Payments data. This would exclude nurse practitioners and physician assistants, who
do not have to report industry payments, and doctors who aren’t enrolled in Medicare. We then
excluded the specialty “Hospitals, General Acute Care Hospital,” bringing the total to 99 common
specialties. (You can see that list below.)

The Physician Compare dataset uses National Provider Identifier (NPI) numbers to identify physicians,
whereas the Open Payments system uses a different unique ID for doctors. In early 2016, ProPublica
matched the physicians in the Open Payments data to their NPI numbers. Our methods were able to
match more than 99.7 percent of physicians in the Open Payments data to their NPI numbers. You can
read more about that process here.

ProPublica then matched the 2014 Physician Compare data with the 2014 Open Payments data, using
physicians’ NPI numbers as the matching key. All told, we found 498,453 doctors in the top 99 medical
specialties who were affiliated with a primary hospital in the Medicare data. Of those, 329,111 received
at least one general payment in 2014 (we excluded research payments.)

For every hospital, we calculated the number of doctors who listed it as the primary affiliation in
December 2014, the number of those who received a payment (and percentage), the total number of
payments to doctors at that hospital, the number who received at least $100 in payments, the number
who received at least $1,000 in payments, the number who received at least $5,000 in payments, and
the number who were promotional speakers. For our national totals, we included all hospitals. But for
our online tool, to avoid inflated percentages when comparing hospital payment rates, we only included
hospitals with 50 or more physicians listed as primary affiliates.

ProPublica then looked at how physician payment rates varied by hospital ownership. To conduct this
analysis, we used data from the American Hospital Association Annual Survey, considered the gold
standard by researchers.

Verifying accuracy

To ensure that we made a proper decision to exclude lesser hospital affiliations, we calculated the
correlation between payment rates for hospitals using only physicians who had a primary affiliation with
the payment rates for hospitals using all listed physician affiliations. We noted a strong correlation at
.93.

Calculating statistical significance

To test the statistical significance of the differences in proportion of doctors taking payments by hospital
ownership types, we conducted a chi-square test. To identify which pairs of ownership types had
statistically significant differences, we conducted post-hoc pairwise chi-square tests with Bonferroni
corrections. All pairs were statistically significant.

Using the same methods, we also tested the significance of differences in proportion of doctors taking
payments by the American Medical Student Association hospital rating. All pairs were statistically
significant. It’s worth noting that AMSA rated 204 teaching hospitals. Our analysis included only 152 of
those hospitals; almost all of the rest were hospitals run by the U.S. Department of Veterans Affairs,
which were not included in our data.

List of specialties analyzed

Internal Medicine
Family Medicine
Anesthesiology
Diagnostic Radiology
Obstetrics & Gynecology
Cardiovascular Disease
Surgery
Specialist
Orthopaedic Surgery
Emergency Medicine
Gastroenterology
Ophthalmology
Psychiatry
Neurology
Pulmonary Disease
Urology
Nephrology
Hematology & Oncology
Anatomic Pathology & Clinical Pathology
Otolaryngology
Hospitalist
Student in an Organized Health Care Education/Training Program
Infectious Disease
Endocrinology, Diabetes & Metabolism
Physical Medicine & Rehabilitation
Podiatrist
Dermatology
Neurological Surgery
Podiatrist, Foot & Ankle Surgery
Rheumatology
Radiation Oncology
Thoracic Surgery (Cardiothoracic Vascular Surgery)
Interventional Cardiology
Vascular Surgery
General Practice
Medical Oncology
Plastic Surgery
Geriatric Medicine
Pain Medicine
Critical Care Medicine
Gynecology
Clinical Cardiac Electrophysiology
Sports Medicine
Vascular & Interventional Radiology
Hand Surgery
Orthopaedic Surgery of the Spine
Allergy & Immunology
Colon & Rectal Surgery
Pediatrics
Plastic and Reconstructive Surgery
Anatomic Pathology
Interventional Pain Medicine
Optometrist
Maternal & Fetal Medicine
Chiropractor
Emergency Medical Services
Gynecologic Oncology
Dentist, Oral and Maxillofacial Surgery
Surgical Oncology
Sports Medicine
Geriatric Medicine
Podiatrist, Foot Surgery
Pain Medicine
Neuroradiology
Adult Medicine
Pediatric Cardiology
Adult Reconstructive Orthopaedic Surgery
Clinical Pathology/Laboratory Medicine
Obstetrics
Child & Adolescent Psychiatry
Trauma Surgery
Surgical Critical Care
Legal Medicine
Hematology
Body Imaging
Otolaryngology/Facial Plastic Surgery
Transplant Surgery
Critical Care Medicine
Foot and Ankle Surgery
Pain Medicine
Orthopaedic Trauma
Hospice and Palliative Medicine
Neuromusculoskeletal Medicine & OMM
Pediatric Radiology
Pediatric Nephrology
Allergy
Podiatrist, Primary Podiatric Medicine
Sleep Medicine
Plastic Surgery within the Head & Neck
Neurology with Special Qualifications in Child Neurology
Nuclear Medicine
Pediatric Anesthesiology
Female Pelvic Medicine and Reconstructive Surgery
Geriatric Psychiatry
Facial Plastic Surgery
Pediatric Hematology-Oncology
MOHS-Micrographic Surgery
Adolescent Medicine
Oral & Maxillofacial Surgery