July 10, 2015
Area(s) of Interest: Health Information Technology Payor Issues and Reimbursement Public Payors
On June 30, the Centers for Medicare & Medicaid Services (CMS) published the 2014 Open Payments data of financial transactions between drug and medical device makers and health care providers. The data includes information about 11.4 million financial transactions attributed to over 600,000 physicians and more than 1,100 teaching hospitals nationwide, totaling $6.49 billion.
The Sunshine Act requires drug and medical device manufacturers and group purchasing organizations to report their financial interactions with licensed physicians – including consulting fees, travel reimbursements, research grants and other gifts.
Last year’s inaugural launch of the Open Payments program was plagued with data inaccuracies and a less-than-user-friendly registration and review process. In year two, the database is much more user-friendly for consumers, allowing them to search for first name, last name and location.
Unfortunately, there are still serious concerns about the accuracy of the data. While CMS says 98.8 percent of the 2014 data was validated, the American Medical Association (AMA) issued a statement that the “vast majority of the data released has not been independently validated by physicians, which makes it less usable for the patients it’s intended to benefit.”
“While we appreciate the efforts of CMS to verify the data submitted by industry, the complicated and cumbersome process for physicians to register to review their data and seek correction of any inaccuracies continues to hinder their participation in the validation process,” AMA said in the statement.
AMA also noted that it opposes inappropriate, unethical interactions between physicians and industry, but that “there are relationships that can help drive innovation in patient care and provide significant resources for professional medical education that ultimately benefits patients.”
If you haven’t already registered for the Open Payments portal, the California Medical Association recommends physicians do so now to obtain access to review and dispute any incorrect data. Physicians should be aware that there is a two-step registration process for the Open Payments program. The first step requires physicians to register at the CMS Enterprise Portal, a step many physicians may have already completed as the gateway enables access to a number of other CMS programs. Step two is to register in CMS’s Open Payments system. (Click here to access the CMS tips to streamline registration.)
More information on the Sunshine Act is available in AMA’s online Physician Sunshine Act Tool Kit, which provides a variety of resources to help physicians navigate the Sunshine Act changes, including a free webinar, a list of important dates, answers to frequently asked questions, information about how to challenge incorrect reports and ways to be more transparent with patients about the physician's interactions with the pharmaceutical and medical device industries.
To view the Open Payments physician payment dataset, click here. To view the searchable public site, click here.