Policy & Regulation News

Open Payment Program Needs Time to Overcome ‘Bad Start’

By Ryan Mcaskill

According to the Journal of the American Medical Association, patience is needed for the Sunshine Act to succeed.

- Transparency has become a major buzzword across the healthcare industry. More regulations are being passed that require hospitals and healthcare organizations to pull back the curtain and expose some of their operations. One of the most noticeable ways this has happened in recent years is the Open Payments Program, also known as the Sunshine Act.

The system was launched earlier this year at the end of September by the Centers for Medicare and Medicaid Services (CMS) and features a wide range of analysis of payments made by drug and device manufacturers to physicians and teaching hospitals. The goal is for patients to know what organizations are paying their doctors. This allows consumers to better understand what could potentially factor into the decision making process of their doctor.

Over the last few months, there have been several upgrades to the systems as well as a matching number of complaints and concerns raised by industry experts and observers alike. The biggest complains have been:

• Data was only collected for five months before the system was brought live because of a delay in CMS issuing its final rules.

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  • • The vetting process was incomplete and only contained 4.8 percent of doctors and 29.8 percent of teaching hospitals. This left more than 12,000 disputed records unresolved and unpublished.

    • There are inaccuracies in the database caused by de-identified payments that are being disputed. A total of $2.2 billion or 39 percent of the payments, including 90 percent of research payments are de-identified.

    • The context of the payments can be misconstrued because field for annotation is limited to 500 characters.

    However, there are some that are coming to the database’s defense and calling for patience. In a recent article from the Journal of the American Medical Association, Dr. Eli Adashi, former dean of medicine and biological sciences at Brown University argues that while the database may be off to a “bad start” it just needs time to straighten out.

    The fact that physicians are paid $4 billion to $5 billion a year by these industries is something that needs to be monitored and reported on. However, it is easy for the database to be taken out of context and abused. Simple changes which are in the works will help alleviate that problem. Adashi even calls for additional information to be reported through new sites that will create an all-encompassing way.

    “Similar doubts pertain to the level of interest displayed by potential unintended audiences (law enforcement agencies, watchdog groups, and health insurance issuers),” the report reads. “The Open Payment Program initiative must be viewed as the most potent antidote for potential conflicts of interest engendered by financial interactions between industry and the health care delivery enterprise. As such, it should be given the benefits of doubt and time.”