WCOE: The Open Payments Data Release

This week, coverage of the release of data on payments by drug and device manufacturers to physicians caught our eye. The Centers for Medicare and Medicaid Services (CMS) released the first round of Open Payments data as mandated by the Physician Payments Sunshine Act provisions of the Affordable Care Act in 2010. The Sunshine Act is intended to provide transparency into financial relationships between manufacturers and physicians. While not all such financial relationships are problematic, studies have shown that financial interactions can influence prescribing habits.

The Open Payments data include consulting fees, research grants, travel reimbursements, and other gifts provided to physicians and teaching hospitals during the last five months of 2013. According to CMS, the database contains 4.4 million payments valued at nearly $3.5 billion attributable to 546,000 individual physicians and almost 1,360 teaching hospitals.

Dr. Shantanu Agrawal, director of the Center for Program Integrity at CMS, said, “Open Payments does not identify which financial relationships are beneficial and which could cause conflicts of interest. It simply makes the data available to the public. So while these data could discourage payments and other transfers of value that might have an inappropriate influence on research, education, and clinical decision-making, they could also help identify relationships that lead to the development of beneficial new technologies.”

Criticism of Open Payments abounds, and most of the critiques fall into a few categories: the quality and accuracy of the data, the lack of context around the data reported, the burden of reporting and verifying data, the cumbersome system for searching and analyzing data, and the missing data that were not reported or were de-identified because of questions about the accuracy.

ProPublica senior reporter Charles Ornstein identifies the limitations of the data in a piece on NPR entitled, “Database Flaws Cloud Sunshine On Industry Payments To Doctors.” Additionally, he writes about the flaws of the system and the challenges in using it in “Analysis: Government’s New Doctor Payments Website Worthy of a Recall.”

A Health Affairs Health Policy Brief describes the background and challenges surrounding implementation of the Sunshine Act provisions and concludes, “However, even those who champion the program agree that simple disclosure is not sufficient to address financial conflicts of interest. Physicians and research centers will also need a reliable framework for determining what kinds of relationships are appropriate, useful, and beneficial. More work is required to ensure that financial conflicts of interest are monitored and regulated appropriately.”

NCCS looks forward to discussing the potential effects of the Sunshine Act and the release of Open Payments data on cancer care at our upcoming Cancer Policy Roundtable in November.