The intertwining relationship between industry and medicine has been evident and ever-so apparent in recent decades. While these relationships are vital for innovation, concerns of potential conflict of interest (COI) have called into question the objectivity of scientific research and patient care. To help alleviate these concerns, the Centers for Medicare & Medicaid Services (CMS) opted to increase the transparency of physician-industry interactions.
The Sunshine Act was passed in 2010 as part of the larger Patient Protection and Affordable Care Act. This mandates that all payments to physicians of greater than $10 from industry (i.e. device manufacturers, pharmaceutical companies, group purchasing organizations) be reported to CMS for upload to the Open Payments Database (OPD). In theory, this makes these payments transparent, enabling patients have access to their physicians’ industry relationships. Additionally, this transparency increases the accountability of both physicians and industry, hopefully reducing conflicts of interest in patient care and research.
You can access OPD online and search for any physician. The type of payments that are reported to OPD are defined by CMS as:
- Acquisitions
- “Buyout payments made to covered recipients who have ownership interest in a company that has been acquired.”
- Charitable Contribution
- “A payment or transfer of value made to an organization with tax-exempt status under the Internal Revenue Code of 1986. Charitable contributions do not include payments or transfers of value that would be more specifically described by one of the other payment categories.”
- Compensation for Non-Consulting Services (i.e., Faculty/Speaker at an event other than a continuing education program)
- “Includes payments that a company makes to physicians for speaking, training, and education engagements that are not for continuing education.”
- Compensation for Serving as Faculty or as a Speaker for a Medical Education Program
- “Compensation for serving as faculty or as a speaker for medical education program.”
- Consulting Fee
- “A payment that a company makes to a physician for advice and expertise about a medical product or treatment. Consulting fees are typically arranged with a written agreement between a company and physician based on the company’s particular business needs. These payments often vary depending on the consulting physician’s expertise.”
- Current or Prospective Ownership or Investment Interest
- “Ownership or investment interest currently held by physicians and teaching hospitals, as well as ownership or investment interest that could potentially be held by physicians and teaching hospitals.”
- Debt Forgiveness
- “Forgiving the debt of a covered recipient, a physician owner, or the immediate family of the physician.”
- Education
- “Payments or transfers of value for classes, activities, programs, or events that involve learning or teaching a profession skill. This payment can include things like textbooks and medical journal articles.”
- Entertainment
- “Attendance at recreational, cultural, sporting or other events that would generally have a cost.”
- Food and Beverage
- “Food and beverage.”
- Gift
- “A general category which includes anything a company provides to a physician or teaching hospital that does not fit into another category.”
- Grant
- “A payment to a physician or teaching hospital to support a specific cause or activity.”
- Honoraria
- “Similar to consulting fees, but generally reserved for a brief, one-time activity. Another distinction is that honoraria are generally provided for services without a set price.”
- Long-term Medical Supply or Device Loan
- “The loan of supplies or a device for 91 days or longer.”
- Research
- “Payments for different types of research activities, including the time a physician spends enrolling patients in studies for new drugs or devices. Research payments can include direct compensation to physicians, funding for research study coordination and implementation, or payments to study participants to cover expenses associated with the study.”
- Royalty or License
- “Payments based on sales of products that use a physician’s intellectual property.”
- Space Rental or Facility Fees
- “Payments for fees associated with renting a space or facility (such as a teaching hospital).”
- Travel and Lodging
- “Any compensation for costs associated with travel, such as hotel fees, airfare, mileage, and cab fare.”
Can these reported payments be disputed? Yes. Every year CMS opens a 45-day pre-publication review and dispute window where the recipient can review reported payments from the previous calendar year and challenge any amount or type of payment with the reporting entity before it becomes public, allowing the reporting entity to correct the information before the data is public. This pre-publication review period is typically from April 1 to May 15. The data is typically publicly released by CMS on June 30th. Any correction requests submitted after May 15 will not be corrected in the publicly visible database until the beginning of the next calendar year.
Overall, OPD serves as a transparent platform to view the types, number, and gross dollar amount of payments being made to a Physician. It is important that neurosurgeons are aware of OPD and how to navigate it appropriately to ensure accurate data is being published to the public.
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Aladine Elsamadicy, MD
Yale-New Haven Hospital
New Haven, Conn.
