Ann M. Parr, MD, PhD, FAANS, FRCSC (left)
Assistant Professor, Neurosurgery, and Director, Spinal Neurosurgery
University of Minnesota
Catherine Miller (right)
Neurosurgical Resident, University of Minnesota
The Open Payments system also known as the Sunshine Act, is a federal program required by the Affordable Care Act (ACA) that collects information about the payments drug and device companies make to physicians and teaching hospitals. The data it collects is provided to the public each year. The purpose of this system was to increase transparency around financial relationships between physicians, hospitals, and drug and device companies. While the landscape of health care is ever-changing, it is important to keep informed on laws, which directly affect the neurosurgery field. Below are some quick facts about the Sunshine Act that every neurosurgeon should know.
What is reported?
- Direct or indirect payments or other transfers of value made to covered recipients (physicians and teaching hospitals), and physician owners or investors; and
- Certain ownership or investment interests held by physician owners or investors, or their immediate family members.
Who is reported on?
- Covered recipient physicians — MD, DO, dentists, podiatrists, optometrist and chiropractors (resident-in-training and non-physician personnel are excluded);
- Covered recipient teaching hospitals — those that receive payments under Medicare direct graduate medical education; and
- Physician owners or investors.
Who is responsible for reporting?
- Manufacturers which engage in the production, preparation, propagation, compounding, or conversion of a covered drug, device, biological or medical supply; and
- Group purchasing organizations (GPOs) which purchase, arrange for or negotiate the purchase of a covered drug, device, biological, or medical supply.
What is the process?
- Data Collection: Manufacturers/GPOs collected data regarding payments made to physicians, hospitals or physician owners/investors;
- Submit Payment Data: Manufacturers/GPOs submit data to CMS Open Payments system;
- Review & Dispute Data: Physician and teaching hospitals can review all records submitted about them by reporting entities and dispute any incorrect data;
- Review & Correct Data: Manufacturers/GPOs can review disputes and correct any data; and
- Data Displayed: The CMS public website displays all data.
How can I view my data?
To review and dispute any data reported in the Open Payments system before its publication, users must follow the two-step registration process to register for the Open Payments system.
- Register self in Enterprise Identity Management (EIDM) via CMS Enterprise Portal; and
- Register teaching hospital and self in the Open Payments system.
Physicians are vetted using information supplied during Open Payments system registration, including name, NPI and state license.
When can review and disputes take place?
The review, dispute and correction period consists of:
- 45 days for data review and dispute by physicians and teaching hospitals; corrections can also be made by reporting entities;
- 15 days immediately following the 45-day period for reporting entities to continue to make corrections; and
- Records with a new dispute initiated after the 45-day review and dispute period will be published as original attested-to data in the initial data publication.
What resources are available for physicians?
There are many resources on the CMS Open Payments website page, including:
- Open Payments User Guide
- Open Payments Review and Dispute Overview for Physicians and Teaching Hospitals
- Register for the CMS listserv, via the Open Payments website, to receive e-mail updates about Open Payments
- Contact the Open Payments Help Desk
What is the most recent data?
In June 2016, the CMS released their data for the 2015 year.
- 9 million total records, 0.13% of which were disputed
- $7.52 billion in payments to physicians and teaching hospitals
- $2.60 billion: general (non-research related) payments
- $3.89 billion: research payments
- $1.03 billion: ownership or investment interests
- As innovators in a highly technology-dependent field, it is no surprise that neurosurgery ranked second among the physician specialties regarding payments received (average total payment per physician = $26,080)
When is the next reporting period?
The 2016 Open Payments review and dispute period begins on April 1, 2017. CMS will publish the 2016 data and updates to 2013, 2014 and 2015 program years on June 30, 2017.
The review and dispute period will remain open until May 15, 2017. Physicians and teaching hospitals must initiate their disputes during this 45-day review period for any disputes to be addressed before the June 30th publication.
Is the data accurate?
There has been ongoing concern regarding the accuracy of this system and in what ways the public may interpret the data. To this end, a study was performed investigating the accuracy of the Open Payments System in regards to neurosurgeons and found several inaccuracies. It searched over 15 million records from 2013-2014 and found that only 62-68 percent of neurosurgeons in the database were correctly identified. Forty-one residents were classified as neurosurgeons, despite the fact that residents are not to be included in the database according to regulatory stipulations. There were also some physicians who were classified as neurosurgeons but were actually from different specialties.
It is without question that collaborations between physicians and biopharmaceutical and medical technology organizations improve patient care and contribute significantly to scientific innovation. However, given the inaccuracies with Open Payments system, it’s also important for all to consider all the implications of disclosure, transparency, and context as more information is publicly released by the administration, and more news outlets delve into the numbers.
Editor’s Note: We encourage everyone to join the conversation online by using the hashtag #HealthReform.