One-Third of Docs’ Payment Data Kept Secret – What’s the Government Hiding?

Next month, the federal government is set to release data on payments to physicians from pharmaceutical and medical device makers as part of the Open Payments database, which is mandated under the Physician Payment Sunshine Act – a provision of the 2010 Affordable Care Act. However, one-third of the records will be withheld due to data inconsistencies, posing yet another hurdle to promoting greater transparency about conflicts of interest in medicine.

The Centers for Medicare and Medicaid Services (CMS) initially discovered flaws in the data while investigating a physician’s complaint that payments were being attributed to him despite being made to another physician with the same name. The CMS found data was “intermingled,” with physicians being linked to medical license numbers or national provider identification numbers that were not theirs. Consequently, about one-third of submitted records are being returned to the manufacturers and group purchasing organizations because of intermingled data and will be included in the next reporting cycle instead. These records, which could number in the millions or even tens of millions, will not be posted until June 2015.

A Continuous Struggle for Transparency

The first release of the database, which will include payments made from August 1 to December 31, 2013, aims to promote transparency about potential conflicts of interest in medicine. To ensure accuracy, physicians were given 45 days to review the data and contest it if they believed the payments attributed to them were incorrect.

However, several physicians have reported that some accurate data has been removed from the system. For instance, one doctor discovered that payments legitimately credited to him were no longer visible on the verification system – only three entries showed up, despite several other valid ones being reported from device maker Medtronic. Another doctor experienced a similar issue, with seemingly legitimate payments from Medtronic, Boston Scientific, and Pfizer disappearing when he logged in.

Government’s Response and Further Actions Required

Although these issues have been flagged up, the federal government is maintaining its commitment to posting the data for public viewing on September 30. Earlier this month, when ProPublica informed CMS of intermingled data, the verification system was temporarily suspended for 11 days while officials investigated. The system went back online, and it was confirmed that physicians will have more time, until September 8, to review their data.

CMS Deputy Administrator and Director of the Center for Program Integrity, Dr. Shantanu Agrawal, stated: “CMS takes data integrity very seriously and took swift action after a physician reported a problem. We have identified the root cause of the problem and have instituted a system fix to prevent similar errors.” CMS claimed to have validated all data in the system, ensuring it was accurate and that incorrect payment transactions were removed from the review and dispute process, thus preventing the data from being published.

However, there was no mention of the fact that, as part of the system fix, a significant portion of the records will not be disclosed next month. Sen. Charles Grassley, one of the main authors of the Sunshine Act, urged CMS to come clean on the scale of the problem and explain what will be public and what won’t be. Incomplete information could prevent the public from obtaining a full picture of payment data, which could be detrimental to the goal of promoting transparency within the medical sector.

Looking Forward

Despite setbacks, it is essential that the medical community and the federal government continue to strive for transparency and combat conflicts of interest in medicine. Providing accurate data is crucial in promoting awareness of potential issues and ensuring that patients can make informed decisions about their healthcare. It is expected that the government will release an explanation regarding the missing data when the public database is launched.

While withholdings and flawed data may hinder progress, it is important for physicians, patients, and the public to be aware of the industry’s efforts to provide greater transparency and to encourage accountable, ethical practices within the medical field.