In just over a month, on September 30th, the Centers for Medicare and Medicaid Services (CMS) is scheduled to publish a searchable online database of manufacturers’ payments to physicians and teaching hospitals. Charles Ornstein of ProPublica reports that CMS will now withhold one-third of the physician payment records from this Open Payments database because of data inconsistencies.
This statement comes in the wake of a problematic roll-out in the weeks before the payment database goes live. On August 3rd, the dispute and resolution period for physicians and teaching hospitals to monitor their industry payments was put on hold after at least one doctor logged into the system and noticed that their information was switched with another doctor with the same name. The system was down for a week and a half. Last Friday, CMS adjusted the 45 day window as follows:
- Review and dispute (45 days): 7/14/2014-8/2/2014 (20 days), 8/15/2014-9/8/2014 (25 days)
- Correction period (15 days): 9/9/14 – 9/23/14
- Public website launch: 9/30/2014
In announcing this adjustment, CMS said that it validated all the data in the system to ensure it was accurate and that “incorrect payment transactions have been removed from the current review and dispute process and this data will not be published.” ProPublica observes that “the release made no mention that, as a part of the fix, a hefty chunk of the records will not see the light of day next month.”
Perhaps most surprising is the news that several physicians found CMS has removed accurate payment data from the database. David E. Mann, who initially blogged about the errors in the CMS system, said he logged into the verification system and discovered that payments “that had been legitimately credited to him were no longer visible. He said only three entries currently show up, even though there were several other legitimate ones from device maker Medtronic that disappeared.” (Propublica)
Another electrophysiologist, Edward J. Schloss of Cincinnati, said that some seemingly legitimate payments attributed to him from Medtronic, Boston Scientific and Pfizer disappeared when he logged in yesterday. “It’s a big change,” he said. “Three of the four companies that have reported payments for me have now disappeared.”
CMS evidently will publish the withheld 2013 physician spend data in June 2015, when 2014 data is to be published as well.
Physician groups, including the American Medical Association (AMA) had repeatedly asked for CMS to adjust its timeline. “In order for the Sunshine Act to be effective, physicians need enough time to review and correct any inaccurate data that may be reported,” said AMA President Robert M. Wah, MD. “The issues that resulted in the system being taken offline further underscore the need for more time than CMS proposes to ensure the system is actually ready and that physicians have adequate time to register, review, and seek correction of inaccurate data. The lack of faith physicians have in the system at this point in time, is making them wonder if taking time away from patients to go through the process is even worthwhile.”
Posting some, but not all, of physicians’ data does not seem to be a beneficial solution in terms of transparency or accuracy. We are curious as to how CMS went about choosing which data to withhold and which data to publish. Without clarity and context from the agency in light of the changes, the Open Payments database will serve to create even more confusion and misinterpretation once it’s published.
We have reported a lot about CMS’ proposal to change the Sunshine Act requirements, including removing the CME exemption from the Act. These data integrity issues and continued delays now further underscore the importance of having CMS maintain the same reporting requirements going in to just the second reporting year of this brand new system.