OBJECTIVE Industry partnerships help advance the field of neurosurgery. Given the nature of the field and its close relationship with innovation, neurosurgeons frequently partner with the medical device industry to advance technology and improve outcomes. However, this can create important ethical concerns for patients. In this paper, the authors sought to comprehensively study how physician payments from medical device companies have changed and what geographic parameters influence the trends observed over the years. METHODS The authors queried and merged several large databases, including Medicare and Medicaid provider usage data and databases from the Open Payments Program, National Plan and Provider Enumeration System, and US Census Bureau. Geospatial analysis was performed using Moran's I and II clustering. Univariate and multivariable analyses were performed using the Mann-Whitney U-test and geospatially weighted multivariable regression for hot spot and cold spot membership. RESULTS Data for 952 counties across the continental United States were analyzed. Ninety-seven counties constituted geographic hot spots. These hot spots were primarily concentrated in Florida, the New York-Pennsylvania region, central Colorado, and southwestern United States. Independent predictors of hot spot membership included greater unemployment rates, the percentage of White patients, the presence of mobile homes, and the percentage of county Hispanic and Black populations. Company-based differences were examined. The vast majority of Medtronic's payments were in the form of royalties and licensing (86.6%). Royalties and licensing accounted for the majority of payments for DePuy (69.4%), Globus Medical (62%), and NuVasive (77.1%). In contrast, other companies, such as Boston Scientific, opted to pay physicians in the form of ownership and investment interests (42.1%). The impact of the COVID-19 pandemic was also assessed. During the onset of the pandemic in 2020, physician payments fell or remained the same across all regions with the exception of the South Atlantic region. However, it was observed that nearly all regions rebounded, with stark elevations in physician payments immediately in 2021. CONCLUSIONS This analysis demonstrates that there are national hot spots and cold spots of physician payments, and offers some social, economic, and company-dependent predictors that may influence the magnitude of payments. Further analysis is needed to better understand this clinical-commercial partnership in healthcare, specifically within neurosurgical practice.

中文翻译：

---

医疗器械公司在神经外科领域的支付趋势：全国范围内的多数据库地理空间分析。

目标 行业合作伙伴关系有助于推动神经外科领域的发展。鉴于该领域的性质及其与创新的密切关系，神经外科医生经常与医疗器械行业合作，以推进技术和改善结果。然而，这可能会给患者带来重要的伦理问题。在本文中，作者试图全面研究医疗器械公司向医生支付的费用如何变化，以及哪些地理参数影响多年来观察到的趋势。方法 作者查询并合并了几个大型数据库，包括医疗保险和医疗补助提供商使用数据以及来自开放支付计划、国家计划和提供商枚举系统以及美国人口普查局的数据库。使用 Moran's I 和 II 聚类进行地理空间分析。使用 Mann-Whitney U 检验和地理空间加权多变量回归对热点和冷点成员资格进行单变量和多变量分析。结果 对美国大陆 952 个县的数据进行了分析。97 个县构成地理热点。这些热点主要集中在佛罗里达州、纽约-宾夕法尼亚地区、科罗拉多州中部和美国西南部。热点成员的独立预测因素包括更高的失业率、白人患者的百分比、移动房屋的存在以及县拉美裔和黑人人口的百分比。检查了基于公司的差异。美敦力的绝大多数付款都是特许权使用费和许可的形式（86.6%）。特许权使用费和许可费占 DePuy (69.4%)、Globus Medical (62%) 和 NuVasive (77.1%) 的大部分费用。相比之下，其他公司，如波士顿科学公司，选择以所有权和投资权益的形式支付医生费用（42.1%）。还评估了 COVID-19 大流行的影响。在 2020 年大流行爆发期间，除南大西洋地区外，所有地区的医生付款均下降或保持不变。然而，据观察，几乎所有地区都出现了反弹，2021 年医生付款立即显着上升。 结论 这项分析表明，全国范围内的医生付款存在热点和冷点，并提供了一些社会、经济和公司相关的预测因素这可能会影响付款的金额。需要进一步分析以更好地了解医疗保健领域的临床商业合作伙伴关系，特别是在神经外科实践中。