Over the weekend, registration for doctors and teaching hospital representatives opened in CMS’s Enterprise Portal, the entryway to CMS’s Enterprise Management System.
It’s the first step physicians must take if they want to review the information submitted about them by manufacturers and group purchasing organizations regarding financial interactions they had with them in the last five months of 2013 and, if necessary, dispute that information. Step two—registration in CMS’s Open Payments system—is set to begin in early July.
But, as physician groups work to inform doctors about the upcoming data release—which could include things like payment for meals, travel, gifts, consulting and research—some are arguing that the registration window is too small to get physicians educated and registered.
The American Medical Association, the country’s largest physician group, is concerned the database might not function properly.
During the Sunshine Act roll-out, “CMS has missed nearly every deadline laid out in the law and regulations to implement it,” wrote AMA President Ardis Hoven, MD, including the March 31 deadline by which companies were supposed to be able to submit aggregate reports.
These delays “raise serious concerns about whether the [Open Payments] database will function properly,” wrote Hoven in a note to members last week reminding them to register. Thus, Hoven continued, “the AMA is still advocating for physicians to have more time to register and review the data.”
The group has previously posted resources for physicians to help them navigate Sunshine changes.
Those who finish the two-step registration will be notified when data has been submitted about them, allowing them to check and challenge data submitted before it becomes public on September 30. This voluntary review and dispute period for physicians and teaching hospitals will be available for 45 days. According to CMS, disputed data that is not corrected by the industry will still go public, but it will be marked as disputed.
“If they miss the first registration, or are too late for the second, they won’t be able to view the data. Their hands will be tied. It’s a big risk,” said Eric Hoffman, spokesperson for the group Partners for Healthy Dialogues, which represents eight different physician societies, including the American Academy of Dermatology and the American Osteopathic Association.
“We’re concerned on two fronts: one, the lack of awareness among the doctor community, and two, the short time frame that they have to sign up for early access to the data in case they need to dispute it,” said Hoffman.
Last November, for instance, a physician poll by QPharma found that 45% of the 300 respondents said they did not know that speaker fees will be reported, even if doctors ask that the money be given to a charitable organization.
“The only downside is—there’s enough time to check, but is there enough time to correct?” said Reid Blackwelder, MD, president of the American Academy of Family Physicians (AAFP). “And that’s the uncertainty: if [the information] is not correct, we don’t know how well the process works to review it and correct it.”
The 45-day window may be sufficient, Blackwelder said, if a payment is “put on hold for correction.” The group provides education through its web page and state chapters.
To avert one of the problems that came to light as a result of the Medicare claims data release earlier this year, AMA’s Hoven strongly urged physicians to make sure their information in the national provider identifier (NPI) database is current.
He was referring to the April 9 release of Medicare reimbursement data at the individual physician level. The data covered utilization by more than 880,000 physicians and other HCPs and spanned nearly 10 million records and more than $77 billion in payments.
According to CMS, these data have been downloaded or accessed more than 300,000 times from the CMS website. (CMS added even more to the data trove today.) But because the release has also come in for some criticism, CMS Administrator Marilyn Tavenner sought to put the data reveal in context.
Stakeholders, particularly physicians, have expressed concerns regarding the accuracy or meaning of the data, wrote Tavenner in an article printed in NEJM on May 28. For example, although utilization data presented in isolation do not reflect the quality of care being delivered, patients may assume they do.
As profiled in the New Yorker, one family physician was slammed with media inquiries after the Medicare data release because she had received more Medicare reimbursement than any other doctor in her state. According to the article, this doctor was actually heading up a demonstration project, and hundreds of Michigan physicians working on the project were all billing Medicare under her name.
This and other points have “some merit,” added Tavenner, “but we concluded that these issues did not outweigh the overall benefit of releasing the data.” That is, to disclose the way in which Medicare pays physicians and other providers.
Who will put the Sunshine data in context? “It would be great if it came from CMS,” said Hoffman.
But he’s not counting on it. His group, which is also backed by the industry trade groups AdvaMed, PhRMA and BIO, is working with physician groups to educate their constituents about the process of getting the contextual message out: that interactions help improve medicine.
As to how many physicians will register for the CMS database, now that it’s open, “We don’t have a good handle on that,” said AAFP’s Blackwelder. “It’s not something we routinely survey.”
