May 26, 2015

On June 30, CMS is going to release information on payments made to physicians during 2014 by pharmaceutical, device and other manufacturers.  This will be an update to the information made public for the first time in September, 2014.  The current database is available at https://openpaymentsdata.cms.gov/.

Open Payments is a national program that promotes transparency by publishing data on the financial relationships between the health care industry (applicable manufacturers and group purchasing organizations, or GPOs) and health care providers (physicians and teaching hospitals).  In 2014, CMS published 4.45 million payment records, transfers of value, or instances of ownership/investment interest that occurred over the last five months of 2013. These financial transactions totaled nearly $3.7 billion.  (CMS, Annual Report to Congress on the Open Payments Program for Fiscal Year 2014.)

The program requires “applicable” manufacturers and GPOs to report payments of $10 or more, or of $100 or more per year in the aggregate, to CMS.  These thresholds have been adjusted since the program began in 2013 to track the consumer price index; the per-item threshold is now $10.21 and the aggregate is $102.07. 

The Open Payments law (Section 6002 of the Affordable Care Act, known as the Sunshine Act) does not impose any obligations on physicians—but readers may nevertheless want to check the information that CMS has posted about them.  The types of “transfers of values” targeted by the Open Payments program include:

• Consulting fees
• Speaker/faculty fees
• Honoraria
• Entertainment
• Food and beverage
• Travel and lodging
• Educational program fees
• Research
• Charitable contributions
• Royalties or licenses
• Investment or ownership interests, other than in publicly traded securities and funds
• Gifts such as flash drives, clocks, pens
• Grants
• Space rental or facility fees

Detailed information, including in particular a list of items that are excluded from the reporting requirements, appears in the MGMA’s paper The Physician Open Payments Program (or “Sunshine”) Act – What You Need to Know as well as on the CMS website, www.cms.gov/openpayments.

Although there are no requirements for physician action, anesthesiologists and pain specialists are encouraged to register with CMS so as to receive direct notice when their Open Payments data are available and to challenge inaccurate, misleading or incomplete data.  Only disputes that were initiated before this year’s 45-day pre-publication review period ended on May 20, 2015 will be flagged and posted when the 2014 data are publicly released on June 30.  Corrections resulting from later disputes will be made the next time CMS updates the Open Payment System.

Registration is a two-step process in which physicians first sign up at the CMS Enterprise Portal, something that many will already have completed as the gateway provides access to a number of CMS programs.  The second step is to register in the Open Payments system, through the portal.  CMS advises that “the entire registration process should take about 30 minutes to complete and must be finished in a single session.  Users cannot save entries or complete their profiles at later times.  To register in Open Payments you should have your NPI, DEA and state license numbers handy.”  Users have the option of nominating authorized representatives such as practice managers who will be able to review and dispute reports going forward.  Once the registration has been submitted, the Open Payments system will perform vetting to ensure that the user is a covered recipient physician.  Nurse anesthetists and other non-physicians are not targeted by the Sunshine Act.  The system will send out an email message confirming the success or the failure of the vetting process.

Perhaps the big question is whether the Open Payments system matters.  The intent of the law is to address concerns that financial ties between physicians and industry may have an undue influence on medical practice and research.  In a February 20, 2015 article in the Wall Street Journal online, What Money? Many Docs Haven’t Visited the Open Payments Database, Ed Silverman reported that 76 percent of physicians surveyed by MedPanel in late 2014 said that their participation with industry activities had not changed since the manufacturers began reporting to CMS in 2013.  Only 46 percent had visited the Open Payments website at all—15 percent admittedly to see what had been reported about their colleagues.  Only nine percent expressed any concern about what their patients might think.

As the public’s interest and experience in checking out their physicians’ reputation grows, however, the accuracy of the information in the Open Payments database may become more important.  Physicians employed by large corporate entities including health systems may find, too, that compliance officers start scrutinizing financial relationships with drug, device and other manufacturers more closely.  The American Medical Association’s advice to try to ensure accurate reporting is therefore worth considering.  The AMA’s Sunshine Act Toolkit recommends, among other things:

• Review and update financial or conflict of interest disclosures required by your employer several times a year.  The employer or other agency requiring such disclosures may compare information posted on the Open Payments website with information you have provided.
• Verify that your information in the National Provider Identifier (NPI) enumerator database is up to date; this information will be used by manufacturers to identify you accurately.
• Ask manufacturers’ representatives to provide you with information on transfers of value before they submit it to CMS.
• Download the “Open Payments Mobile for Physicians” app on your Apple™ or Android™ device.  This simple, easy-to-use tool will allow you to track transfers of value in real-time, as they occur throughout the year, and to validate information submitted by manufacturers about payments.

Although the Open Payments Program is about transparency only and does not prohibit transactions between manufacturers and physicians, the information that it publishes has the potential to affect physicians’ reputations. It is worth making sure that the information is correct.

With best wishes,

Tony Mira
President and CEO