Open Payments: What You Must Know Now

Feeling a little in the dark about the Sunshine Act and Open Payments? Here’s a quick guide to shed some light on the topic:

The Story

The big money that some physicians collect beyond their salaries blazed across headlines in the popular press this past week.

“Drug and medical-device makers paid $6.49 billion to U.S. doctors and teaching hospitals during 2014, according to the federal government’s first full-year accounting of the breadth of industry financial ties with medical providers,” WSJ and scores of other media outlets reported.

Many articles highlighted outlier physicians, such as one nephrologist who pulled in $594,363 in consulting and speaking fees, travel expenses, and meals during 2014. Some articles mentioned physicians getting what seem like luxury perks unrelated to medical care, including “a $65 massage at an airport, Alcatraz tickets and a $2,000 payment for a training seminar in the Cayman Islands.”

Why You Should Care

Most articles encouraged readers to look up their own doctors on CMS’s site or on easier-to-use sites utilizing the same government data (such as Pro Publica’s Dollars for Docs). Patients who heed this advice probably won’t learn you accepted half-a-million like the outliers, but they will see the total cost of those lunches the Allergan rep treated you to last year. They may also see consulting fees that seem like small change to you, and big dollars to them.

Not Ego-Surfing. Just Due Diligence.

You should drop by the CMS site to check your own data. If you are a practice manager, you should drop by to check your doctors’ data.

Think of it as this month’s version of googling yourself.

This is the second time the government has released Open Payments data. The first data set (released last fall) covered the last half of 2013. One thing companies, physicians and consumers could all agree on? The data contained inaccuracies.

Fun Fact: Open Payments is brought to you by CGI Federal, which you may remember as the contractor that gave Healthcare.gov its infamously rocky rollout.

What Else?

The legislation implementing Open Payments passed way back in 2010, so I appreciated the recap from Shantanu Agrawal (Medical Director, CMS Center for Program Integrity) and Theodore Doolittle (health care attorney with LeClairRyan) at the American Health Lawyers Association Annual Meeting this past week. Here are some key takeaways:

  • The Sunshine Act does not require doctors to report anything about themselves. Providing the data is the responsibility of drug and device companies that make the payments, so that’s one piece of red tape you get to skip.
  • Physicians may review the data prior to publication. See an error? Take it up directly with the company that has reported the data.
  • Think Open Payments are a pain? At least they’re not Stark. They may well be a less bureaucratically complex way to accomplish the clunky Stark Law’s overall intent. Good news for everyone—providers, regulators, and patients alike.
  • Open Payments data do not include money companies spend on samples they leave at your office, independently-administered continuing education, payments to PAs and NPs, or payments related to new products awaiting FDA approval. Those payments are made public after FDA approval or four years after the payment, whichever comes first.

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