Medicare’s Open Payments Database Brings Transparency, Controversy

On September 30 of this year, the federal government made public any financial transactions between for-profit companies and physicians that took place during the prior year. As stipulated by the Physician Payments Sunshine Act, the Center for Medicaid and Medicare Services (CMS) has created the Open Payments program database, in which pharmaceutical and device manufacturers report on “transfers of value” to individuals, and the data goes up on the program’s website.

The database is huge and has too many columns to be easily viewed across even two computer screens. You can customize your view and run a search, but it’s sometimes glitchy. Still, the main goal has been accomplished: Patients—or anyone—can type in their physician’s name and find out if they have received monies (or gifts or lunches) from industry.

The motivation behind the Open Payments database is, of course, transparency. And most people agree that transparency is a good thing. What often gets lost in this discussion—and is a major cause of concern—is that, at present, the data is presented without much context. The CMS website says it plainly: “Open Payments does not identify which financial relationships are beneficial or which may cause conflicts of interest.”

And that is where the controversy and concern come in.

The Importance of Context

“Information without context isn’t transparency,” said Heather Pierce, JD, MPH, senior director of science policy and regulatory counsel for the Association of American Medical Colleges (AAMC).”If you don’t understand the data, you’re not better informed.”

Further, some of the transactions listed in the database are questionable, said David Nielsen, MD, executive vice president and CEO of the American Academy of Otolaryngology-Head and Neck Surgery. “It’s not unlikely that a physician who would say they’ve never taken money will still find themselves listed on the Open Payments website.”

This discrepancy is due to the fact that the rules for reporting make it safer for companies to overreport than to underreport. So a company might provide a buffet lunch at a meeting and then take the list of attendees and divide out the cost. “Physicians can challenge data like that,” said Dr. Nielsen. “I know it’s an extra effort, but we [at AAO-HNS] think it’s important to do—dispute it and get it fixed.”

It’s tough to know what patients might make of seeing industry funding to their physicians. Patients should remember that physicians are integral to research and development efforts for new drugs and devices, said Barbara Barnes, MD, associate vice chancellor for continuing education and industry relationships at the University of Pittsburgh Schools of the Health Sciences. “We want our physicians to do research—industry-sponsored research,” she said, noting that the summary data includes royalties. “The only ones who can develop useful new tools are the ones who use them every day in practice.”

Conversations

So what makes a good payment and what makes a bad one? These are the questions physicians are grappling with. “The Sunshine Act has started a lot of conversations that weren’t there before,” said Pierce. “It’s an important conversation to have in our community.”