Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

CMS Releases First Set of Open Payments Data

By Elizabeth Snell

- The Centers for Medicare & Medicaid Services (CMS) released the first round of Open Payments data this week. The move is part of a larger effort to help consumers understand the financial relationship between the health care industry, and physicians and teaching hospitals.

The first bit of information released publicizes drug and device company payments to teaching hospitals and physicians.

With this new data, a wide range of analyses of payments made by drug and device manufacturers can now be conducted, explained Dr. Shantanu Agrawal, deputy administrator and director of the Center for Program Integrity at CMS.

“Open Payments does not identify which financial relationships are beneficial and which could cause conflicts of interest,” Agrawal said in a statement. “It simply makes the data available to the public. So while these data could discourage payments and others transfers of value that might have an inappropriate influence on research, education, and clinical decision-making, they could also help identify relationships that lead to the development of beneficial new technologies.”

The Open Payments program was created under the Affordable Care Act (ACA), and lists consulting fees, research grants, travel reimbursements, and other gifts the health care industry given to physicians and teaching hospitals during the last five months of 2013. According to CMS, the data contains 4.4 million payments valued at nearly $3.5 billion attributable to 546,000 individual physicians and almost 1,360 teaching hospitals.

CMS sees this as an opportunity for the public to learn about the relationships among healthcare providers, as well as pharmaceutical and device companies, said CMS Administrator Marilyn Tavenner.

“This initial public posting of data is only the first phase of the Open Payments program,” Tavenner said. “In coming weeks, we will be adding additional data and tools that will give consumers, researchers, and others a detailed look into this industry and its financial arrangements.”

Over the summer, manufacturers submitted data to CMS and the agency performed initial matching to aggregate payments to a single physician or teaching hospital. Registered physicians and teaching hospitals were able to review payments reported about them and dispute information they believed inaccurate. More than 26,000 physicians and 400 teaching hospitals registered to review payments attributed to them.

According to CMS, approximately 40 percent of the records published this week are de-identified.  The data will be fully identifiable in 2015 after the reporting entity submits corrected data and physicians and teaching hospitals have a chance to review and dispute.

The American Medical Association (AMA) was hesitant about the Open Payments system and urged CMS to give providers more time for registering and using the system to review claims. Instead, the AMA proposed a deadline of March 31, 2015 to ensure physician participation and that the data was accurate. However, upon the release of Open Payments data, the AMA said it appreciates CMS’ efforts, but it is very concerned about the accuracy of the data.

A main concern was that only 26,000 physicians out of the nearly 550,000 physicians affected by the Sunshine Act were able to register to review their data, the AMA said. 

“Several factors unfortunately hindered participation by many of the physicians impacted including a complex, non-user friendly and cumbersome registration process to review data and request corrections of any inaccuracies,” said Robert M. Wah, MD, AMA President. “Meanwhile, the government website was plagued by repeated shut downs and other issues. Notably, CMS has indicated problems with one-third of the data, which raises significant questions about the accuracy of the data content.” 

Wah added that the AMA is looking forward  to working with CMS to improve the Open Payments system to ensure that information is presented in an accurate and informative way to patients. 



Join 30,000 of your peers and get free access to all webcasts and exclusive content

Sign up for our free newsletter:

Our privacy policy

no, thanks

Continue to site...