CMS' Open Payments updates to boost transparency, data analysis — What surgeons need to know

Alan Condon -  

CMS' Open Payments program requires drug and devicemakers to report payments or transfers of value to physicians, teaching hospitals and other providers to increase the transparency of these relationships.

The agency refers to drug and devicemakers and group-purchasing organizations as "reporting entities" while providers are referred to as "covered recipients." 

Orthopedic devicemakers are among the biggest spenders in the medtech industry when it comes to payments made to physicians.

Under CMS' 2022 Physician Fee Schedule proposal, issued July 13, the agency proposed changes to support the usability and integrity of this data for the public, researchers and CMS.

Six notes and updates for surgeons to know:

1. Open Payments reports three types of records:

  • General payments (includes categories such as food and travel)
  • Research
  • Ownership interest

2. Reporting entities flag thousands of general payments for publication delay each year to keep a record from being publicly available because it contains sensitive research and development information. Only payments associated with research should be delayed for publication.

To address this, the agency is "proposing language that will clarify the impermissibility of delaying general payments, and that research-related payments do not need to have been specifically outlined in the original research agreement to be reported as research payments," according to a July 13 news release.

3. Open Payments requires reporting entities to disclose payment to teaching hospitals, but stakeholders argue that teaching hospital records often don't have enough information to verify that the record was properly reported. This can lead to disputes, with covered entities requesting more information from the reporting entity, which creates more work for both parties.

CMS plans to add a required field to teaching hospital records to combat this. The field would only be available to the teaching hospital disputing the information.

4. Physician-owned distributorships are a subset of group-purchasing organizations but are not specifically defined in Open Payments. CMS proposes to include a definition for these entities and require them to "self-report and identify" to combat potential conflicts of interests between providers and reporting entities.

5. CMS also plans to address an overlap between general and ownership payments. Currently, there is a nature-of-payment category for ownership that is separate from ownership and investment interest, which is another separate record. An entity can submit one or both types of record for ownership.

The proposal aims to eradicate confusion around these two types of records and facilitate data analysis by having one type of ownership record.

6. Reporting entities undergo an annual recertification when they submit records, so companies can update their system information, but this is unavailable for companies that do not have any records to report.

To address this, CMS plans to give companies the option to recertify and declare that they do not have any records to submit for a reporting year. CMS said this will simplify communication about compliance between the agency and reporting entities.

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