Open Payments currently presents a vague portrait of how pharmaceutical and device manufacturers interact with physicians. The Centers for Medicare and Medicaid Services (CMS) noted on Monday that $3.3 billion out of $4.6 billion total payments from industry are either missing or de-identified. View their Fact Sheet here.
Upon release of the database on September 30, Open Payments showed $3.5 billion in payments in various categories. This included 1.7 million records, totaling $2.2 billion, which were de-identified. On Monday, CMS announced that they actually withheld an additional $1.1 billion from the database. This makes the total $4.6 billion in industry payments from August – December 2013. While the missing $1.1 billion includes $551 million in research payments for new drugs (which were allowed a four year reporting delay), $514 million in payments have not been published due to “unresolved disputes at the end of the review period.”
Physicians in the Database
CMS states that 546,000 physicians are identified in the Open Payments database. According to the National Bureau of Labor Statistics, the total physician population (as defined by CMS) is 926,400:
| MD’s/DO’s |
691,400 |
| Dentists |
146,800 |
| Chiropractors |
44,400 |
| Optometrists |
33100 |
| Podiatrists |
10,700 |
| Total |
926,400 |
Thus, just under 59% of physicians have some relationship with industry. Yesterday we noted that tiny payments make up the majority of data in the Open Payments system. Around 120,000 transactions in the general payments category with identifiable information are for transfers of value less than $3. More than 1.2 million records in the identifiable payment category are for payments—in many cases meals—that cost less than $15.
The Dispute Resolution process of Open Payments was contentious among physician groups and manufacturers alike. Doctors argued that manufacturers should not be allowed to “unilaterally” dismiss their disputes. However, once the 45-day dispute window began, the real problem turned out to be the cumbersome registration and log-in process, as we highlighted in depth here.
When it was all said and done, just 26,000 physicians registered to review their payments. This equates to only 4.8 % of the 546,000 physicians with attributed payments. Physicians actually disputed only 12,579 records. According to CMS’s fact sheet, 9,000 disputes remain unresolved–approximately 71.5% of the total amount disputed.
These 9,000 unresolved payments totaled a $514 million, an average of $57,111 per transaction. Thus, physicians tended to dispute large payments. We will be interested to see if these transactions end up in the database.
I hope this is just some infrastructure problem in the database, not an actual ‘physical’ disappearance of the money. Because that is a lot of money!