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CMS releases data on $3.5B in industry payments

CMS releases data on $3.5B in industry payments to doctors, teaching hospitals

Originally posted by Mary Ellen Schneider of Internal Medicine News Digital Network

The federal government publicly released the first data about drug and device industry payments to physicians and hospitals, part of a push toward greater transparency that was mandated under the Affordable Care Act.

On Sept. 30, the Centers for Medicare & Medicaid Services published 4.4 million records of payments to about 546,000 individual physicians and nearly 1,360 teaching hospitals. In total, the records represent $3.5 billion in financial transactions between the industry and health care providers.

The Open Payments program, known previously as the Sunshine Act, requires medical device manufacturers and pharmaceutical companies to report payments and transfers of value to physicians and teaching hospitals, including consulting fees, research grants, travel reimbursements, ownership interests, and other gifts.

The data released on Sept. 30 cover only payments made from August through December 2013. Data on payments made in 2014 are slated to be published in June 2015.

But the program has been plagued by delays and technical problems. CMS had to extend multiple times the 45-day “review and dispute” period, during which physicians could check the accuracy of data reported about them. It took the agency days to correct technical problems that had caused data to be intermingled, matching the wrong records to physicians with similar names.“We are taking a big step forward in shining the light on these financial arrangements between physicians and the health care industry,” said Dr. Shantanu Agrawal, director of the CMS Center for Program Integrity. “Using [these] new data, it is now possible to conduct a wide range of analyses of payments made by drug and device manufacturers that were never possible before.”

Of the 4.4 million records released on Sept. 30, about 40% had to be de-identified either because of data inconsistencies that kept CMS from being able to match them to an individual physician or teaching hospital, or because the data were not available for review for the full 45-day period. CMS expects the data to be fully identified in 2015 once the manufacturers submit corrected information.

Another 199,000 records that were reported to the agency were not published at all, according to CMS. The vast majority of those records were unpublished at the request of the industry, since they related to ongoing research of unapproved treatments. About 9,000 records were not published because they are under active dispute, according to Dr. Agrawal.

While physicians and the industry have been generally supportive of CMS’s move toward greater openness about payments, there has been plenty of criticism of the implementation of the Open Payments program. The American Medical Association has said repeatedly that physicians have not had enough time to review the accuracy of the payments and that CMS is not providing adequate context about what the payments actually say about physician-industry relationships.

“Publicly reporting industry payments to individual physicians can imply, wrongly, that such payments are always inappropriate,” the AMA wrote in a guide for reporters covering the release of Open Payments data. “Some may be, but to be able to make an informed judgment, it is vital to be able to set the financial information in context. Just because a physician has a relationship with industry does not automatically mean that his or her professional judgment has been influenced inappropriately.”

The AMA also said that the process of registering and later reviewing payments was confusing and overly cumbersome for physicians. Only about 26,000 physicians and 400 teaching hospitals registered in the Open Payments system to review their data, according to CMS.