The Physician Payment Sunshine Act has evolved into the Centers for Medicare and Medicaid Services (CMS) Open Payments program. While the name has changed, the intent of this program is the same: to increase the transparency of the financial relationships that physicians and teaching hospitals have with pharmaceutical and medical device manufactures and group purchasing organizations (GPOs). As part of the program, manufacturers must report payments and other transfers of value they have made to physicians and teaching hospitals each calendar year. Manufacturers and GPOs must also report certain ownership or investment interests held by physicians or their immediate family members. Reports are made to CMS by March 31 of each year. Physicians and teaching hospitals will have 45 days to review and dispute the data before it is posted publicly around June 30.
ASTRO urges all members to understand the impact of this program and has prepared the following frequently asked questions to help members better understand this program.
Open Payments requires reporting of the following information annually to CMS:
CMS collects, aggregates and publishes this data on a public website.
Note: medical students, residents, support and office staff, nurses, advance practice nurses, physician assistants and others are excluded from the reporting requirement.
Manufacturers must report payments and transfers of value made directly or indirectly to physicians and teaching hospitals and GPOs must report such payments or transfers to physicians with ownership or investment interests. Manufacturers as well as GPOs are also required to report ownership interests held by physicians and their immediate family members. When a report is made, payments and other transfers of value must be categorized as falling into one of the following possible categories:
1CMS adjusts these numbers each year based on the consumer price index for all urban consumers (CPI-U). For 2016, the exclusion applies to payments or transfers of value less than $10.22, unless the aggregate exceeds $102.19 in a calendar year.
Manufacturers and GPOs must submit the reports on payments and transfers of value to CMS on an annual basis. Manufacturers and GPOs must report ownership interest held by physicians and their immediate family members1.
1CMS defines immediate family members to include a:
Once the manufacturer has submitted data listing the physician’s name to CMS, CMS must give physicians 45 days to review and work with the manufacturer, or applicable GPO, to correct the information. After the 45 days have passed, the manufacturer or applicable GPO will have an additional 15 days to submit corrections based on any disputes identified by physicians and physician owners/investors. The review and correction period starts at least 60 days before the information is made public.
During the review and correction period, physicians and physician owners/investors can dispute information about them they do not think is correct. If data is disputed, CMS will notify the applicable manufacturer or applicable GPO that some of their data has been disputed. However, CMS will not mediate the dispute directly.
CMS has announced the following program cycle for the 2015 Open Payment program: