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