CUMC

Federal Sunshine Act/Open Payments Program

Last modified on 8/18/2014, 11:30am

The Office of Academic Affairs is working to provide accurate and up-to-date information for faculty and researchers about the roll out of the Sunshine Act Open Payment system. There may be times when the most recent information is only available on the CMS website.

Detailed information is available on the CMS website http://www.cms.gov/Regulations-and-Guidance/Legislation/National-Physician-Payment-Transparency-Program/Program-Registration.html

Please note, you must register before you can review your information. According to the AAMC, "physicians have no reporting obligations under this regulation but should consider reviewing the reported informatino before it becomes public."

You will only be able to view what has been reported about you if you have registered. If you haven’t already registered, gaining access to your information is a two-step process. You can register at https://portal.cms.gov/wps/portal/unauthportal/home/.

Stanford University has a helpful step-by-step document that may assist with the registration process. It is available at http://doresearch.stanford.edu/sites/default/files/documents/CMS%20Tips%20%28troubleshooting%29%207-28-14_1.pdf

According to CMS, "physicians and teaching hospital representatives can register in Open Payments system. The Open Payments review and dispute process began on July 14 and ends September 8, 2014. The review, dispute and correction process allows physicians and teaching hospitals to review and initiate any disputes regarding the data reported about them by applicable manufacturers and applicable GPOs before CMS makes the information public on September 30, 2014."

The federal CMS Open Payments website was down last week. CMS has changed the deadline for the review and dispute process, previously August 27, 2014.

A user guide from CMS is available at http://www.cms.gov/Regulations-and-Guidance/Legislation/National-Physician-Payment-Transparency-Program/Downloads/Open-Payments-User-Guide-%5BJuly-2014%5D.pdf

Please note, there have been reports of problems reviewing individual’s information. Open Payments portal website is managed by CMS. For problems, please reach out to CMS directly by email to openpayments@cms.hhs.gov or by phone at 855-326-8366.

WHAT IS THE SUNSHINE ACT OPEN PAYMENTS PROGRAM?
Physician Payment Sunshine Act (“Sunshine Act”) is a provision of the Affordable Care Act. By law, starting in 2014 a publicly available federal website, “Open Payments” will display information about payments and other “transfers of value” (defined below) from manufacturers to individual doctors (defined as M.D., D.O., D.D./D.D.M., D.D.S., D.P.M., O.D. and D.C.P. who are licensed in any state in the U.S., whether or not they are practicing) and teaching hospitals be made available to the public. (The Act does not affect faculty and staff members who are not physicians, as defined above.)

According to CMS: “Open Payments is a national disclosure program that promotes transparency by publishing the financial relationships between the medical industry and healthcare providers (physicians and hospitals) on a publicly accessible website developed by CMS.”

Individual physicians will be responsible for checking their information posted on the site and for contacting manufacturers to address any discrepancies.

WHAT’S NEW?
According to CMS, "physicians and teaching hospital representatives can register in Open Payments system. The Open Payments review and dispute process began on July 14 and ends September 8, 2014. The review, dispute and correction process allows physicians and teaching hospitals to review and initiate any disputes regarding the data reported about them by applicable manufacturers and applicable GPOs before CMS makes the information public on September 30, 2014."

There will be a 45-day period “following initial availability of the Open Payments system [to] review, dispute, and correct data submitted by industry.”

Once CMS establishes the online portal, physicians will be encouraged to sign-up to receive direct notice when the reports are made available to physicians prior to CMS posting on the public website.

WHAT SHOULD P&S FACULTY DO?
We strongly encourage all of our physicians to register with CMS so as to receive notifications when CMS receives a payment report on the individual.  Physicians will need to register to review their data.

Individuals will be identified using their NPI number, so this information is needed for registration. Please be advised that during registration it is our understanding that you need to have your NPI as well as your taxonomy code(s) (which CMS is calling a specialty code).

Individual physicians will be responsible for reviewing the accuracy of reported data and addressing any discrepancies.

We advise all of our physicians to keep thorough documentation for all outside activities involving industry in case you need it to dispute information posted in the Enterprise Portal. It is unclear for how long CMS will keep open any disputes, so we recommend that you maintain records for at least five years.

After registration, individual physicians can appoint one delegate to monitor records on the CMS website. According to the AAMC, "physicians can appoint a delegate and those delegates must also register and accept their rold before they can review a physicians' data."

KEY DATES
Data Collection: Starting on August 1, 2013, manufacturers began collecting information and providing CMS information about such payments, including the amount and purpose.

Registration for the Open Payments Website: Beginning June 1, 2014. Columbia physicians may want to register promptly so that they can review these data as soon as it becomes available.

Previewing of Individual Information: Began on July 14, 2014

Dates for Dispute of Individual Information: Timeframes for dispute are limited by CMS. Information on industry payments to individuals is now available (as of July 14, 2014). According to CMS, one has until September 8, 2014 (45-days from release) to “review, dispute, and correct data submitted by industry.” 

Date of Release: CMS has announced that most of the data will be released on the public website on September 30, 2014, and once annually thereafter. The initial data release will cover industry payments from August 1, 2013 through December 31, 2013. According to the AAMC, "historic data will continue to be available indefinitely."

WHOSE INFORMATION DOES IT LIST?
Only MDs and other providers, such as those with a DO or DDS. Posting will NOT include residents, fellows or other providers, such as NPs.

Reviewing: Physicians will need to register with the site to preview their own information and, if needed, work with manufacturers to correct payment information.

Disputes: Physicians are responsible for correcting their own information, if needed. See below.

WHAT INFORMATION WILL THE FEDERAL WEBSITE CONTAIN?
Payments to individuals will be listed by the physician’s name. Payments will not be listed by the physician’s place of employment or appointment. Sponsored research will be listed by institution and will name individual PIs, also possibly investigators (TBD).

Reporting: Payments must be reported by industry to the Centers for Medicare and Medicaid Services (CMS). Information posted will include detailed information about payments and other “transfers of value” worth over $10 from manufacturers to physicians at teaching hospitals.

Categories of Payment and Transfers of Value : Manufacturers will cover companies that manufacture drugs, devices, biologicals or medical supplies and are required to provide a category for the services rendered. There are 14 categories of payment and transfers of value to physicians including: consulting fees, compensation for speaking or other services, travel, food, entertainment, gifts, honoraria, royalties or licenses, charitable contributions, education, current or prospective ownership or investment interest, etc. (Information about research grant reporting is available below.) According to AAMC, "any payment or transfer of value that does not fit into one of the other categories noted above is considered a gift... Examples might include office supplies, journal reprints, textbooks, editorial services, and scientific posters, if they did not fit into another category."

Types of Payment: Manufacturers are required to categorize how the recipient received the payment (such as cash or cash equivalent, in-kind items or services, or stock, stock option(s), or any other ownership interest, dividend, profit, or other return on investment).

Indirect Payments: Manufacturers must collect and provide information about indirect payments as well as payments made directly to physicians. For example, if a physician is paid indirectly through a third party (e.g., contract research organization, travel agency), the payment will be listed as a transfer from the manufacturer to the physician.

Research support: Physicians who are investigators on research supported by manufacturers will be listed in connection with the research payments to the institution, even if payments for research are made to the institution. These payments will be reported on a separate research reporting section of the web site.

Ownership: Manufacturers as well as GPOs are required to report on interests held by physicians and their immediate family members. Ownership or investment interests in publicly traded security and mutual funds are excluded.

WHAT INFORMATION WILL BE EXCLUDED?
Payments to physicians for serving as faculty or speakers for accredited Continuing Medical Education activities are generally not included. Exclusions also include, buffet meals, product samples, educational materials for patients, short-term loaned medical devices, items worth less than $10.

Additional exclusions are listed in the FAQs in the AMA Toolkit for Physician Financial Transparency Reports (Sunshine Act).

HOW TO PRE-REVIEW YOUR INFORMATION?
CMS has announced that information on industry payments to individuals is now available (as of July 14, 2014). According to CMS, one has until September 8, 2014 (45-days from release) to “review, dispute, and correct data submitted by industry.” 

Physicians will need to register with the site to preview their information and, if needed, work with manufacturers to correct payment information.

To access their individual reports, physicians will need to complete a two-phase process.

Phase 1 requires identify verification in the CMS Enterprise Identity Management System (EIDM). Initial registration for the Open Payments system became available on June 1, 2014 and is at https://portal.cms.gov/wps/portal/unauthportal/registration

Phase 2 enables physicians to select access to the Open Payments System. Registration for Phase 2 will be available in mid-July. Registration for phase 2 became available on July 14, 2014 and is at https://portal.cms.gov/wps/portal/unauthportal/registration

HOW TO DISPUTE YOUR PREVIEWED INFORMATION?
Individual physicians will be responsible for contacting manufacturers to address any discrepancies.

CMS has established specific deadlines for the processes of reviewing, disputing and correcting individuals’ information.

Information about and dates for the review, dispute and correction processes are available at http://www.cms.gov/Regulations-and-Guidance/Legislation/National-Physician-Payment-Transparency-Program/Dispute-and-Resolution.html

According to CMS, “applicable manufacturers and applicable GPOs should work with the disputing physician or teaching hospital to correct disputed data. Applicable manufacturers or applicable [business] must send CMS a revised report to make the corrections and re-attest to the updated data.”

CMS has stated that it “will not mediate any dispute.”

Once CMS establishes the online portal, physicians will be encouraged to sign-up to receive direct notice when the reports are made available to physicians prior to CMS posting on the public website.

CMS is providing a free mobile app to help physicians keep track of, store, and view financial payments and other transfers of value from applicable manufacturers. The app is available at https://itunes.apple.com/us/app/open-payments-mobile-for-physicians/id667567467?mt=8

WANT MORE INFORMATION?
More detailed information about the Sunshine Act is available from the Centers for Medicare and Medicaid (CMS) Services: http://www.cms.gov/Regulations-and-Guidance/Legislation/National-Physician-payment-Transparency-Program/index.html

To receive updates from CMS, you may register for the listserv by emailing OPENPAYMENTS@cms.hhs.gov

Faculty physicians who have questions about faculty disclosure requirements may contact the P&S Office of Academic Affairs (http://www.cumc.columbia.edu/faculty) or the CU Office of Research Compliance and Training (http://www.columbia.edu/cu/compliance/docs/conflict_interest/index.html).

ADDITIONAL RESOURCES
CMS The Official Website for Open Payments (Physician Payments Sunshine Act):  http://www.cms.gov/Regulations-and-Guidance/Legislation/National-Physician-Payment-Transparency-Program/index.html

CMS, "Crosswalk: Medicare Provider/Supplier to Healthcare Provider Taxonomy": http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Downloads/TaxonomyCrosswalk.pdf

AMA, Toolkit for Physician Financial Transparency Reports (Sunshine Act): http://www.ama-assn.org/ama/pub/advocacy/topics/sunshine-act-and-physician-financial-transparency-reports.page

AAMC, The “Sunshine” Final Rule: https://www.aamc.org/download/330310/data/sunshinepresentation.pdf

CMS Open Payments Mobile for Physicians: https://itunes.apple.com/us/app/open-payments-mobile-for-physicians/id667567467?mt=8

Johns Hopkins Medicine, Physician Payments Sunshine Act: http://www.hopkinsmedicine.org/Research/OPC/Policies_Regulations/Sunshine_Act

The information listed here was obtained from the websites of CMS, the AMA and Johns Hopkins University School of Medicine (accessed 7/2/2014).

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