In the wake of the Open Payments Program enactment, physicians are beginning to feel the shift in their business relationships manufacturers and/or group purchasing organizations (GPOs). The Open Payments Program, also known as the “Physicians Payment Sunshine Act” established under the Affordable Care Act (ACA) requires any manufacturer of medical devices, drugs, and biologicals that participate in U.S. federal health care programs to report certain payments and items of value given to physicians and teaching hospitals to the Centers of Medicare and Medicaid Services (CMS). In addition, manufacturers and GPOs must report to CMS certain ownership or investment interests held by physicians and their immediate family members. Applicable manufacturers and GPOs began collecting the data on August 1, 2013. The first data reporting requirement takes place on March 31, 2014 and will cover all data collected from August through December of 2013.
The purpose of the Open Payments Program is to promote transparency and create a system that represents the interactions between physicians and industry. The key to establishing ethical ground rules of transparency will be recognizing these relationships in a positive light as an ultimate benefit to the patient.
Physicians may witness slowed scheduling of meals provided by representatives, limits on textbook and article reprint handouts, and decreased attendance at manufacturer-sponsored dinners and speaking engagements. Reported financial information will be available on public domain beginning September 30, 2014, leaving some practices concerned that the data could unfairly distort the positive nature of the collaborative relationships that physicians maintain with the industry. Additionally, since textbooks and article reprints will be considered reportable under Open Payments and becomes a concern for physician education and quality of patient care, the AUA has joined with other advocacy groups to ask CMS to reconsider the sharing of scientific and medical information as a reportable value.
To better equip physicians in the reporting process, the AUA has also created a toolkit containing important timeline dates, links to CMS updates, physician information to be reported, guidelines for speaking events, and more. Additional CMS tools include a mobile app for data capture, a fact sheet for physicians outlining the categories of reportable materials, Frequently Asked Questions (FAQs) and more. It is imperative that reporting physicians create or verify a National Provider Identifier (NPI) number to ensure their transactions are accurately attested. Physicians will have the right to review and challenge erroneous reports during a 45-day “review and correction period” but to do so, they must actively be aware and tracking all activities and payments exchanged with manufactures to ensure accuracy. Physicians are encouraged to register with CMS early in 2014 in order to track “payments” and verify accuracy prior to the publication on the Open Payments website. For more information, CMS has developed an official website on Open Payments.
The AUA continues to monitor the regulation changes of the Program. If there are any questions about the Physicians Payment Sunshine Act, please contact the Reimbursement and Regulation Department at R&R@AUAnet.org.