On Tuesday, August 2, 2016, The Centers for Medicare & Medicaid Services (CMS) hosted a Special Open Door Forum. The Special Open Door Forum was hosted for the CMS to obtain input from Open Payments stakeholders to inform future rulemaking and other enhancements to the program.
CMS is not currently under any statutory deadline or implementation schedule that is forcing the agency to make any changes to the current rule. However, stakeholder feedback is valued as CMS continues to move forward in enhancing the Open Payments system and refining the reporting requirements. According to CMS, the “focus is on increasing efficiency and minimizing burden while maintaining the goal of transparency in the healthcare industry.”
Comments from Stakeholders
Comments from stakeholders varied, as some comments came from healthcare providers (even physicians themselves) and some comments came from industry. Providers and industry sometimes agreed on a better way to do things, while other times the groups disagreed.
Much of the call discussed teaching hospitals and difficulties with reporting. For example, one caller worked within a hospital system with five teaching hospitals. The way Open Payments reporting is currently set up, it is hard to determine which teaching hospital is the one receiving each individual payment, since they all fall under the same corporate umbrella and tax ID number. The caller suggested that perhaps Open Payments can add a non-Public data element for providers to see to differentiate between hospitals, such as adding the Medicare provider number.
CMS once again reiterated the call for comments and suggestions from industry as to how teaching hospitals can be better defined and proper reporting better facilitated, so that payments are reported more accurately.
CMS/Open Payments Account
One caller noted that there is no way to opt out of the year long Open Payments process and that the current CMS accounts close after six months of inactivity; this caller in particular was wondering if there is a way for physicians to get notifications if they have been identified as having taken payments from industry, so they are reminded to log in more frequently to check, or if there is a way to change the CMS account system so that they are active for thirteen months instead of the current six. CMS’ comment was that there is no way to opt out, except decline to take payments, and that the six month window is a security system for the protection of users, but they will take the feedback under advisement.
There was a bit of discussion surrounding current payment categories and whether additional payment categories should be added. One suggestion was to broaden the ownership category to include ongoing investment in firm or acquisition by a third party in which a physician has had ownership interest in the past.
Another comment was that as currently understood by that particular organization, the gift category is more or less a “de facto catch all” category for payments not easily put into any other payment category. They suggested that there be an payment category as an actual catch all.
Some members of the industry spoke out about how much additional work it would take on their end if there were additional categories, noting that oftentimes, current categories are both broad and specific enough to capture most of the payments made.
One physician spoke out and suggested that training and procedural workshops should be excluded from Open Payments reporting. They understood that, yes, there is a transfer of value there, but it is one that is not necessarily a conflict of interest; instead, it is one that actually betters patient care.
A caller from the medical industry requested that there be a way for physicians to be able to certify that payments are being linked to the right person. For example, right now, if Mary Jones, cardiologist, goes in to check her payments, there may be payments attributed to another Mary Jones, cardiologist in her list, but without NPI or some other identifying information, there is no way to confirm that those payments were linked to the correct Mary Jones. CMS noted that the statutes prohibit NPI numbers from being published in public data, but offered advice to go in and verify that the data is attributed properly through the registration process and review and dispute any incorrect payments.
There wasn’t much discussion about the review and dispute process, but one comment received was a suggestion that when disputes are initiated, the disputer should be required to input their telephone number and email address so they can easily be contacted.
The Open Payments Solicitation can also be found in the proposed 2017 Physician Fee Schedule. If you have any questions about the Open Payments data, the website, or how to report, please contact email@example.com. Any feedback and questions about the solicitation in the Physician Fee Schedule or the Open Door Forum can also be submitted to firstname.lastname@example.org.