Over the weekend, the Centers for Medicare and Medicaid Services (CMS) submitted their annual report to Congress on the first year of Open Payments. Each year, CMS is required to submit a report to Congress summarizing the payments made by applicable manufacturers and group purchasing organizations to physicians and teaching hospitals, as well as any penalties CMS assessed based on noncompliance with the program. The document is an interesting “inside-look” into CMS’s activity, and offers the industry an idea of where the agency is headed with Open Payments, including program implementation improvements, and, perhaps more importantly, where CMS is focusing their enforcement efforts.
The report, available here, first provides a high level overview of the Open Payments reporting requirements, as well as highlights from the first year of the program. CMS includes a number of familiar summary statistics, including an aggregate payment chart as well as a 50+ page appendix that lists every reporting entity and the dollar amounts attributed to that company (Appendix B, p. 33).
The report is most interesting where CMS provides insight into its auditing process and its plans for the future. Since companies first began instituting aggregate spend systems to comply with the Sunshine Act, the question has always been, how will CMS interpret the complicated law for enforcement purposes? For now, it seems like the agency is focusing on companies who simply did not register or submit any data.
To date, CMS has not imposed any civil monetary penalties against any applicable manufacturers or GPOs for noncompliance. However, CMS states that they will launch targeted audits to identify applicable manufacturers and GPOs that should have submitted payment information but did not for 2013.
“As of the date of this publication, CMS is engaged in an effort to increase submission compliance of specific entities that did not submit data,” CMS states. “The near-term objectives of the Open Payments compliance strategy are focused on alerting applicable manufacturers and GPOs to their failure to register and submit data in the Open Payments system." (emphases added)
Beyond the first program year, applicable manufacturers and GPOs will be notified of their failure to report in a timely, accurate and/or complete manner, notes CMS.
Open Payments System: Planned Improvements for Program Participants
As we have outlined in a number of articles, the Open Payments platform has not always been very user friendly from either the submitting entity's standpoint, or the reviewing physician's. CMS states that they are making multiple system enhancements based on stakeholder feedback to address this.
The report states that the 2015 reporting cycle will include the following upgrades:
- More intuitive and user-friendly system screens, including just-in-time guidance via on-screen messages, which provide guidance directly at the point in the process where users require it.
- Record download capability for applicable manufacturers and GPOs, allowing them to download records already reported into the Open Payments system.
- Improved user identity management approach that ensures fully synchronized user accounts between EIDM and Open Payments.
- Enhancements to enable deactivation of users no longer requiring access to the system.
- Enhancements to the review and dispute functionality for physicians and teaching hospitals, including enabling covered recipient primary investigators to dispute their associations with the research study to which the reported payment was related.
- Enhanced matching logic used to attribute transactions reported by applicable manufacturers and GPOs to correct covered recipients. The upgraded matching logic will minimize the chances of conflicting data being processed by the system and data being attributed improperly.
Planned Enhancements to Open Payments Website
The report also lays out CMS’s planned enhancements to the Open Payments website. CMS plans to provide summary information of all Open Payments data in a data dashboard layout. Similar to the data summary fact sheet CMS already provides on the Open Payments website, this dashboard will give visitors an aggregate view of all Open Payments data by providing statistics such as total dollar amount of all payments and transfers of value, total number of entities that made payments, and total number of physicians who received payments.
CMS also continues to solicit stakeholder assistance to make enhancements to the public website. "Combining this feedback with 2014 data to be published in June, 2015, CMS will provide more opportunities for all site visitors, from the advanced data user to the general public, to discover meaningful information in the Open Payments data published by CMS," the report states.
By outlining the Sunshine Act's reporting requirements, providing an overview of the first year of data collection, and shedding a bit of Sunlight onto CMS's own internal processes and future plans, the report is an important document for both those newly acquainted with Open Payments, and seasoned aggregate spend experts.
View CMS's report on Open Payments to Congress here.