Physician Payments Sunshine Act: Comments For and Against CMS Including Open Payments Data on “Physician Compare” Profiles
On July 15, 2015, the Centers for Medicare & Medicaid Services (CMS) published its proposed rule to update the Medicare physician fee schedule for 2016. Among the many proposals, CMS sought comment on whether to add Open Payments data to its “Physician Compare” website. The comment period closed last month; we have provided a list of comments listed by whether they were supportive or against the proposal.
Background
CMS launched the first phase of Physician Compare on December 30, 2010, and so far the website mainly contains physician identification information as well as whether they participate in various “Quality” programs, including the Physician Quality Reporting System (PQRS), Electronic Prescribing (eRX) Incentive Programs, and Electronic Health Records. (You can search your doctor by name or specialty here). In its recently released Call for Comment (see page 123), CMS proposed to add additional data to each doctor’s Physician Compare page, including Open Payments data.
According to CMS, “[c]onsumer testing has indicated that [Open Payments] data are of great interest to consumers.” Open Payments is a searchable database that lists physicians next to the payments or transfers of value they receive from the pharmaceutical and device industry–such transactions may include meals, consulting arrangements, travel expenses, research payments, speaking fees, and a host of other industry interactions. “Consumers have indicated that this level of transparency is important to them and access to this information on Physician Compare increases their ability to find and evaluate the information.”
Thus, CMS sought comment about including Open Payments data on individual physician pages. “Although these data are already publicly available, consumer testing has also indicated that additional context, wording, and data display considerations can help consumers better understand the information,” the agency states. “We are now seeking comment on adding these data to Physician Compare.”
Comments Received
Many stakeholders contributed comments opposed to the proposed change to Physician Compare. AdvaMed, for example, noted that Physician Compare focuses solely on high level data, and lacks the proper context to allow patients and other consumers the ability to understand the details surrounding a doctor’s industry relationship. Such context is necessary to avoid “discouraging beneficial interactions critical to the development and safe and effective use of innovative medical technologies.” They propose instead that CMS provide a reference or a link to Open Payments on a physician’s profile.
BIO, the trade association representing biotech companies, similarly urged CMS to provide a reference or hyperlink to Open Payments rather than a simple dollar figure, if the agency follows through on the proposal at all. “This approach is consistent with the rather spare content and format of the information currently presented on the physician profiles of Physician Compare, BIO writes. “It also avoids the need to determine how best to present the necessary context on Physician Compare to help users understand the voluminous and potentially confusing information available on CMS’s Open Payments website.”
The American Medical Association (AMA), the largest association of physicians in the US, spoke out strongly against CMS including Open Payments financial data on Physician Compare. “The AMA does not support the inclusion in Physician Compare of any data that has not been validated for accuracy by a covered recipient,” AMA wrote. “Though the Open Payment Program was established to increase transparency in the financial interactions of physicians and manufacturers of drugs, devices, and medical devices, CMS has not implemented adequate measures to ensure the accuracy of the data submitted by the industry.”
PhRMA’s comment against the addition of Open Payments to Physician Compare is worth a full read (see page 9), but they essentially argue that instead of CMS expending resources into making Open Payments data available on a separate website, the agency should instead “devote its resources to the continued development and enhancement of the Open Payments website.”
“Our members report repeated instances in which users are confused by the current presentation of data,” PhRMA writes. “For example, physician principal investigators continue to dispute research payments and transfers of value made to an institution, because they believe that the Open Payments site represents that the total research payment is affiliated with only the principal investigator.” PhRMA member companies similarly “report confusion regarding other third-party payments” such as where “a company provides a grant to a patient advocacy organization, and the organization uses some portion of that grant to fund awards to physicians, the payment may be reported in the name of the recipient physician as an indirect payment.” PhRMA is concerned that while “the name of the third party is also reported, we understand that some physicians have expressed concern that the manner in which the payment is displayed on the Open Payments website incorrectly suggests a direct financial relationship between the physician and patient advocacy organization.” The Association is concerned that a dollar figure on a Physician Compare profile will not provide necessary context to how a doctor works with industry.
While most of the comments in favor of the proposed change do not explain the position beyond noting their support of the additional Physician Compare metrics, the American Academy of Physician Assistants (AAPA) explained that including Open Payments data in a link would be the best approach. Thus their recommendation would be consistent with some of the associations and societies opposed to the proposed change.
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