Physician Payments Sunshine Act data scheduled for release

By September 30, data on payments and other transfers of value made to physicians and teaching hospitals will be available via a searchable federal database. The Physician Payments Sunshine Act (Sunshine Act), also known as Open Payments, was established under the Affordable Care Act and seeks to increase transparency of the financial relationships between the medical industry and health care providers to the public. The Sunshine Act requires applicable manufacturers (AMs) of drugs, medical devices, biologicals, and medical supplies to track payments and other transfers of value to physicians and teaching hospitals and report these payments to the Centers for Medicare & Medicaid Services (CMS) annually. AMs and group purchasing organizations (GPOs) must also report certain ownership interests held by physicians and immediate family members to CMS. Data will be made publicly available in a searchable database by September 30 for this reporting year and by June 30 in subsequent years.

As implementation of the Sunshine Act gains momentum, there are several reporting factors that surgeons need to know about before data become available.

For instance, although the Sunshine Act does not impose any penalties on physicians, registration in the Open Payments system is required for physicians to review and dispute their data. This column discusses the registration process, types of data included in the Open Payments system, the review and dispute process, key dates, and recommendations from the American College of Surgeons (ACS) concerning the Sunshine Act.

Is registration mandatory, and how do I enroll in the Open Payments system?

Physicians are not required to register or send information to the Open Payments system unless they want to review and dispute reports. It is recommended, however, that surgeons participate in this process, so they may dispute and correct information they believe to be inaccurate or incomplete. Physician registration was conducted in two phases for this first reporting year1:

  • Phase 1 began June 1 and includes user registration in CMS’ Enterprise Portal.
  • Phase 2 began July 14 and includes physician registration in the Open Payments system to complete the registration process and begin reviewing data submitted by industry prior to public posting. Note that registration in the Enterprise Portal is required to register in the Open Payments system.

What is included in the reports?

AMs are required to identify reportable payments using one of the categories listed in Table 1.2

Table 1. Categories of reportable payments

Consulting fees Grants Honoraria
Gifts Entertainment Current or prospective ownership or investment interest
Travel and lodging Education Compensation for serving as faculty or as a speaker for an unaccredited and non-certified continuing education program
Charitable contributions Royalty or license Compensation for serving as faculty or as a speaker for an accredited or certified continuing education program
Research Food and beverage Compensation for services other than consulting, including serving as faculty or as a speaker at an event other than a continuing education program

How will the review/dispute process unfold?

Table 2 provides a summary of the review, dispute, and correction process and timing.3

Table 2. Review, dispute, and correction processes

Time period

What happens during review?

What happens during dispute?

What happens during correction?

Days 1–45 Physicians review their information before it is made public. Physicians may dispute information reported about them.Disputes initiated in this 45-day period that go unresolved will be in the public database but shown as “under dispute.”CMS will not mediate any dispute. AMs and GPOs should work with physicians to correct disputed data.AMs or GPOs must send CMS a revised report to make the appropriate corrections and re-attest to the updated data.
Days 46–60 AMs and GPOs work to resolve disputes received from physicians.Physicians may continue to review their information. Physicians may continue to initiate disputes during this period, but resolutions may not be reflected in publicly displayed data.CMS will not mediate any dispute. AMs and GPOs should work with physicians to correct disputed data.Corrections made to disputes issued in this 15-day window (and resubmitted) may not be in the public database.AMs and GPOs must send CMS a revised report to make the appropriate corrections and re-attest to the updated data.

Table 3 describes how the dispute initiation and resolution timing affects the public display status of the data. CMS will update corrected data from the current and previous year at least once annually, in addition to the initial publication that followed the data submission. Updates will be included when possible during this period of data refresh.

Table 3. Dispute initiation and resolution timing—Impact on public display of data

Timing of dispute initiation

Dispute resolution
status within 45-day initial period or 15-day correction period

Public display status

Within 45-day initial review, dispute, and correction period

Resolved

Published as non-disputed in September 2014

Not resolved

Published as disputed in September 2014
After current 45-day initial review, dispute, and correction period, but before 45-day period preceding subsequent data refresh

Resolved

Published as non-disputed in both September 2014 and the subsequent data refresh

Not resolved

Published as non-disputed in September 2014 and disputed in the subsequent data refresh

CMS notes the following:

  • Data corrections made by AMs and GPOs may be submitted at any time.
  • If the AM or GPO is unable to resolve the dispute with the physician in the initial 45-day or subsequent 15-day period, both parties should continue to seek a resolution.
  • In the cases where a dispute cannot be resolved, the latest attested-to data submitted by the AMs or GPOs will be published and marked as disputed.

May I delegate Open Payments access to other users?

Yes, once physicians have registered in both the CMS Enterprise Portal and Open Payments system, they may designate one authorized representative who may review and dispute data on their behalf. Physicians may select one of three access levels for their authorized representative:

  • View only, which will enable the authorized representative to view only the data that were submitted about the physician
  • Review and dispute, which will enable the authorized representative to dispute records that were reported relating to that physician
  • Modify profile, which enables the authorized representative to modify information in a physician’s profile, such as updating their business address or phone number

The representative must register through the CMS Enterprise Portal and Open Payments system as well. The authorized representative will be able to view a physician’s first and last name, business address, business telephone number and e-mail address, National Provider Identifier, and state license numbers. The authorized representative will not have access to physician user IDs or passwords and will be unable to modify or reset them.4

What are key dates to keep in mind?

  • June 1, 2014: Phase 1 of physician registration in CMS’ Enterprise Portal began. Physicians may register at any time.
  • July 14, 2014: Phase 2 of physician registration in the Open Payments system began. Physicians had 45 days immediately following this date to review and correct data and have it reflected in the September 30, 2014, public database.
  • September 30, 2014: Data from 2013 will be released on a searchable public database.
  • June 30, 2015, and beyond: Data from the previous year will be released on a searchable public database.

What does the ACS recommend surgeons do with respect to this statute?

The College recommends that surgeons take the following actions:

  • Become familiar with the information that will be reported about physicians
  • Keep records of all payments and other transfers of value received from AMs and GPOs
  • Register with CMS and subscribe to the listserv to receive updates on the Open Payments program
  • Register in CMS’ Enterprise Portal and Open Payments system to review information AMs and GPOs submitted on physicians’ behalf
  • Work with AMs and GPOs to make sure the information submitted about physicians is correct
  • Keep track of payments and transfers of value made to physicians and be mindful of ownership and investment interests held by both physicians and their immediate families4

Additional resources of information on Open Payments

To track reportable payment transfers on your smartphone, download a free app via:


References

  1. The Centers for Medicare & Medicaid Services. Open payments: Physicians. Available at: http://www.cms.gov/Regulations-and-Guidance/Legislation/National-Physician-Payment-Transparency-Program/Physicians.html. Accessed July 8, 2014.
  2. The Centers for Medicare & Medicaid Services. Fact sheet for physicians. Available at: http://www.cms.gov/Regulations-and-Guidance/Legislation/National-Physician-Payment-Transparency-Program/Downloads/Physician-fact-sheet.pdf. Accessed July 8, 2014.
  3. The Centers for Medicare & Medicaid Services. Dispute and resolution. Available at: http://www.cms.gov/Regulations-and-Guidance/Legislation/National-Physician-Payment-Transparency-Program/Dispute-and-Resolution.html. Accessed July 8, 2014.
  4. The Centers for Medicare & Medicaid Services. MLN Connects National Provider Call: Open Payments: CMS registration overview. Available at: http://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events-Items/2014-06-12-Open-Payments.html?DLPage=1&DLSort=0&DLSortDir=descending. Accessed June 12, 2014.

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