CMS Opens Sunshine Act Review

CMS Opens Sunshine Act Review
Physicians have 45 days to review and dispute payments from industry.

The Ophthalmology Innovation Summit opening on Thursday is clear evidence of the advances that can come with clinicians and industry working together.

But such cooperation comes with oversight.

The Centers for Medicare and Medicaid Services (CMS) has opened its Open Pay-ments system to allow physicians to review and dispute payments they’ve received from device makers and pharmaceutical companies, as they’ve reported them under the so-called Sunshine Act. The data consist of fees, grants and other payments drug and de-vice makers paid to physicians and teaching hospitals for all of 2014.

The release is part of the Open Payments program, also known as the Physician Pay-ment Sunshine Act, under the Affordable Care Act. The first release last year included only data for the last five months of 2013.

The review and dispute period lasts 45 days, and the information is due to be released to the public on June 30. Data that are the subjects of disputes filed within the 45-day period will be withheld from the June 30 release, according to CMS. Physicians may al-so file disputes after the review and dispute period ends, but those changes won’t ap-pear until next year’s reporting cycle.

Eli Y. Adashi, MD, MS, a professor at Brown University in Providence, R.I., encourages physicians who receive significant commercial support to take advantage of the review and dispute period. “The key argument in looking at the data is to ensure accuracy, but not just in dollar amounts, but the breakdown of support into categories to see that they’re appropriately characterized,” he says.

Any company that sells drugs or FDA-approved devices through Medicare, Medicaid or the Children’s Health Insurance Program, along with group purchasing plans, are re-quired to report consulting fees, research grants, travel reimbursements and other gifts.

The 2013 data listed 4.45 million payments totaling nearly $3.7 billion. Some 1,419 manufacturers and group purchasing plans paid that out to 546,000 individual physi-cians and 1,360 teaching hospitals. The 2013 data omitted $1.1 billion in payments be-cause of problems with the data.

However, last year only 26,000 physicians, or 4.8 percent, registered in the Open Pay-ments system to review the payments attributed to them.

Dr. Adashi explored the problems with the 2014 data release in an article in the Journal of the American Medical Association.1 “Last year was different,” he says in an interview. “There really wasn’t all that much time. The website was clunky and, worse, it failed and had to be taken off line for close to two weeks.” He expects CMS to correct those prob-lems this time around.

To review the information, physicians must register in both the CMS Enterprise Portal and the Open Payments system. Physicians who registered last year do not need to register again; they can login with their user IDs and passwords and navigate to the Open Payments system home page. Registration is available on the CMS website at:
cms.gov

REFERENCE

1. Santhakumar S, Adashi EY. Viewpoint: The Physician Payment Sunshine Act; Testing the value of transparency. JAMA. 2015;313:23-24.

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