Open Payments Program: CMS Publishes Program Year 2021 Data Less than 5% of Payments to NP’s and PA’s
On June 30th, the Centers for Medicare & Medicaid Services (CMS) announced the publication of Program Year (PY) 2021 Open Payments data. A total of 12.10 million records were published and $10.90 billion in payments or other transfers of value were provided to covered health care providers during PY 2021.
PY 2021 marks the first year of the reporting of payments or transfers of value provided to physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists and anesthesiologist assistants, and certified nurse midwives, as required by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act of 2018 (SUPPORT Act). The data shows that less than 5% of all payments went to these clinicians.
In addition, PY 2021 includes new/updated reporting categories (acquisitions, debt forgiveness, compensation for serving as faculty or as a speaker for medical education program, and long-term medical supply or device loan), the requirement to add the identifiers for certain medical devices and medical supplies, and the covered recipients’ National Provider Identification (NPI) in the published data set.
PY 2021 data also shows a slow return to “normal” following lockdowns and other restrictions due to the COVID-19 pandemic.
General Payments
There was over a 96% increase in the number of general payments reported compared to PY 2020 (11.42 million vs. 5.82 million number of payments reported). However, the difference in total dollar value of all general payments between PY 2021 and PY 2020 was negligible ($2.55 billion vs. $2.10 billion).
The main contributor behind the significant increase in the amount of payments reported over the previous program year was due to the food and beverage nature of payment category (10.7 million vs. 5.2 million number of payments reported). The expansion of Open Payments to include physician assistants and advanced practice nurses also contributed to this increase (3.5 million out of 10.7 million). Overall, food and beverage also accounted for over 91% of the number of payments reported within the general payments category (10.7 million out of 11.6 million).
We also continue to see evidence that companies are not carefully reviewing their data prior to submission and attestation. For example, a Tennessee-based regenerative medicine company reported a $21,600 meal to a single physician and the total amount of food and beverage spend attributed to the physician by the company was over $67,000. The likely explanation is that this company selected the wrong category of spend. Despite this minor error, it could lead to third parties, such as investigative journalists, local reporters, patients, and even the government, questioning the spend. CMS has the authority to impose civil monetary penalties of up to $1,000,000 as adjusted annually on reporting entities if they fail to report information in a timely, accurate, or complete manner.
Research Payments
The Research Payments category continues to remain the “king” of expenditures. Since 2015, the category has steadily increased year-over-year and has accounted for over 59% of all payments disclosed ($41.89 billion out of $70.95 billion). For PY 2021, research-related payments accounted for over 65% amongst the reporting categories ($7.09 billion out of $10.90 billion).
In analyzing the amount of research-related spend disclosed by over 1,700 companies, the top 20 entities accounted for over 70% of all spend within this category ($5.01 billion out of $7.09 billion). Pfizer Inc.’s research-related payments alone accounted for approximately 10.5% of spend and over 32% of the payments were attributed to the Pfizer-BioNTech COVID-19 vaccine, COMIRNATY® ($242,734,243.91 out of $742,440,882.29).
Ownership or Investment Interests
Reported spend related to ownership or investment interests increased by over 4% compared to the previous program year (from $1.21 to $1.26 billion). Overall, a physician covered recipient and an immediate family member of a physician covered recipient accounted for over 38% of spend within this category.
CU Medical Inc., a company that specializes in IV therapy products, systems, and services, reported that a director on the company’s board of directors, George A. Lopez, M.D., held an interest through stock or stock options valued at over $290 million. Midmark Corporation, a global manufacturer and supplier of healthcare products, equipment and diagnostic software for medical, veterinary, and dental markets, reported that an immediate family member of Robert C. Klamar, M.D., Anne Eiting Klamar (chair of Midmark’s board of directors) held common stock valued at over $198 million. The Open Payments Program requires reporting entities to report ownership or investment interests that are held by the physician or the physician’s immediate family members.
The Expanded Covered Recipients
PY 2021 marks the first year of the disclosure of payments and transfers of value provided to physician assistants and advanced practice nurses (“Non-Physician Practitioners”). The data clearly shows that physicians remain the primary target by companies. Non-Physician Practitioner accounted for approximately 4.75% of the total amount of general payments ($121.05 million vs. $2.55 billion) and 0.01% of the total amount of research payments ($423,392.27).
Drilling down into the Non-Physician Practitioner data further, spend attributed to the nurse practitioners accounted for over 65% of all spend ($78.5 million out of $121.05 million), followed by 32% attributed to physician assistants ($39.2 million out of $121.05 million), and the remaining 3% spread out amongst the remaining advanced practice nurses. Food and beverage was the top category of spend amongst all Non-Physician Practitioners with the exception of anesthesiologist assistants.
We expect subsequent program year data to show similar spending trends.
