ASH Clinical News December 2014 | Page 76

FEATURE Sunshine Act Data Follow the Money During a five-month period in 2013, drug and device manufacturers paid doctors and teaching hospitals nearly $3.5 billion. Here’s a brief breakdown of where that money went: • Research payments: $1.49 billion • Speaking and consulting fees: $380 million • Royalties and licenses: $302 million • Promotional talks and honoraria: $228 million • Consulting: $158 million • Travel, lodging, and entertainment: $96 million •  ood and beverage: F $93 million •  rants, education, and G facilities: $70 million • Training: $19 million • Ownership and investment: $11 million These payments were made to approximately 546,000 individual physicians and almost 1,360 teaching hospitals, from 1,419 manufacturers and group purchasing organizations who reported payments. As of September 30, 2014, a small portion of physicians and hospitals registered to review payments – but that number will likely increase: • More than 26,000 physicians and 400 teaching hospitals registered to review payments the website provides so little context for the public – especially considering that the site was originally designed to inform and educate patients. “I support transparency, but I also want people to be aware that there have to be relationships between physicians and industry to help further the practice of medicine,” Dr. Burns said. “Conflictof-interest measures are clearly put into place to ensure that physicians act in an appropriate manner, but it will only harm patients if we are not able to continue to have close working relationships to bring novel drugs and devices to patient care.” Dr. Dweik also fully supports the idea of transparency. The major difference, though, between the conflicts of interest made public on Cleveland Clinic’s website and those made public in the Open Payments system, is that the Cleveland Clinic attempts to put these relationships in context for its patients as part of the overall individual physician profile, he said. “With the CMS system, patients can see if a physician was paid a certain amount, but they have no way of knowing if that amount was reasonable or not,” Dr. Dweik said. The Open Payments system could detail a variety of industry/physician relationships. Some of those relationships are appropriate, Dr. Dweik said – for example, attending an industry-sponsored educational lunch, helping to invent a device or procedure and receiving royalties, or possibly being a sought-after thought leader in a particular specialty. In other cases, the ethics of the relationships might be more questionable. In a statement announcing the publication of the data, CMS wrote: “Financial ties among medical manufacturers’ payments and health-care providers do not FIGURE 2. necessarily signal wrongdoing. Given the importance of discouraging inappropriate relationships without harming beneficial ones, CMS is working closely with stakeholders to better understand the current scope of the interactions among physi- “ system like [Open Payments] A would be most helpful if it provided contextual information, and that is not necessarily the case right now.” —RAED DWEIK, MD cians, teaching hospitals, and industry manufacturers. CMS encourages patients to discuss these relationships with their health-care providers.” In addition, CMS does provide a page on its Open Payments website called “Open Payments Data in Context” to help users learn about Open Payments and what it may mean for physicians, industry, and patients. “We believe a system like [Open Payments] would be most helpful if it provided contextual information, and that is not necessarily the case right now,” Dr. Dweik said. Public Access and Transparency Finally, Dr. Dweik mentioned that the current Open Payments search system is not very user-friendly. Although the goal of the site is to get potential conflicts of interest out to the public, Dr. Dweik questioned how easily the public will even be able to gain access to this information. The Open Payments CMS homepage • 12,579 records were disputed • 9,000 record disputes remained unresolved • 17,994 records were affirmed Stay tuned for another refresh of Open Payments data: Beginning in June 2015, future reports will be published annually and will include a full 12 months of data. Case in point: A Google search for “Sunshine Act” – arguably the most popular term associated with the financial relationships between the doctors and medical manufacturers – does not point to the Open Payments website. Interested parties need to know the name “Open Payments” to find the appropriate site. Once on the homepage (FIGURE 2), it is not immediately evident how one could begin to search for a specific physician’s name and payment information. (Editor’s note: In response to complaints about the difficulty in searching the Open Payments database, CMS implemented a search tool option on Octobe r 17, allowing users to search “identified data” for physician name, teaching hospital, or company making payments. “Identified data” refers to data that were matched by CMS to a single doctor or teaching hospital and available for review and dispute for 45 days. However, according to CMS, a significant portion of the first wave of Open Payments data is “de-identified” due to inconsistent and inaccurate payment information and, thus, not searchable with this tool.) While more work may be necessary to improve the Open Payments system, Dr. Burns said that ASH fully supports the idea of transparency in the industry and the Sunshine Act and encourages physicians to take the requirements of the law very seriously. “Our membership needs to be aware of how the Sunshine Act affects them and affects the health-care industry,” Dr. Burns said. “Any questions they have should be forwarded to ASH, which is working for them on a national level.” Contact Brian Whitman, Senior Manager for Policy and Practice, at [email protected]. ● Sources • American Society of Hematology. Statement from ASH President Linda J. Burns, MD, on release of Sunshine Act data. www.hematology.org/ Newsroom/Press-Releases/2014/3250.aspx. Accessed November 3, 2014. • Centers for Medicare & Medicaid Services. Open Payments System Reopens, Extends Physician Registration and Review Period. Accessed from www.cms.gov/Newsroom/MediaReleaseDatabase/ Press-releases/2014-Press-releasesitems/2014-08-15.html. • Centers for Medicare & Medicaid Services. Open Payments data fact sheet. Accessed from www.cms. gov/OpenPayments/Downloads/Fact-Sheet-Sept-302014-Published-Data.pdf. • David Mann. Dark clouds for the Sunshine Act. Accessed from www.epstudiossoftware. com/?p=1536. Source: www.CMS.gov 74 ASH Clinical News December 2014