Next month the federal government’s database of drug company and medical device manufacturer payments to doctors is supposed to launch. But it won’t be as we expected.
As reported by ProPublica.org, about one-third of the records will be withheld because of data inconsistencies. Keep in mind that although the Physician Payments Sunshine Act was passed in 2011 as part of the Obama administration’s health-care reform, and the database, Open Payments, was supposed to be available to the public last year, it has been delayed until now.
Withholding information seems to be trending: A few weeks ago, courtesy of USA Today, we blogged about the feds not reporting some serious hospital errors on its Hospital Compare website.
Open Payments is supposed to disclose payments industry makes to doctors for research, consulting, speaking, travel and entertainment as an effort to clear up — and, one hopes, clean up — conflicts of interest and the appearance of them. If your doctor chooses a certain kind of implant for your hip replacement, and he or she also has been paid to promote it at surgeon conventions, can you be sure that choice for you is completely for medical reasons? Or because the doctor likes getting two paychecks?
The first Open Payments release, scheduled for Sept. 30, covers payments made from Aug. 1 to Dec. 31, 2013.
The Centers for Medicare and Medicaid Services (CMS) has been investigating physician claims that payments were being attributed erroneously. The agency reported that, indeed, one physician’s payments were being recorded as being sent to another one with the same name. The feds said they found "intermingled data”— medical license numbers or national provider identification numbers linked to the wrong people — that had to be corrected before being made public.
These data won’t be included in the database until the next reporting cycle, which is June 2015.
CMS did not tell ProPublica how many records were involved, but it could be as many as tens of millions.
Certainly, it is in no one’s interest to publicize erroneous information. But it’s troubling that, like the rollout of the state and federal health insurance exchanges last year, a federal health-care initiative once again has proved to be balky, tardy and sloppy.
Before CMS makes the data public, it has allowed physicians 45 days to review and contest entries they believe are inaccurately attributed to them. When a physician in Louisville, Ky., found payments attributed to him that should have been attributed to a doctor with the same name in Florida, ProPublica reports, CMS suspended the verification system for 11 days to investigate. And now, physicians have until Sept. 8 to review their data, even though CMS has promised to stick with the Sept. 30 deadline for public access.
This vigilance is to be commended … except that when CMS promised not to post anything that hadn’t been validated, it didn’t mention that one-third of its records won’t appear on Sept. 30.
And, because some physicians told ProPublica that some of the data being withheld was accurate, you wonder about the quality of the whole program.
One physician said that only three entries for him currently show up, although several other legitimate ones from a device maker should be there. Another doctor reported that what he thought were legitimate payments attributed to him from three difference device makers or drug companies weren’t recorded under his name.
Supposedly, according to a follow-up by CMS, consumers will be given an explanation about the missing payments when the database launches. But doctors told ProPublica that they didn’t see such a notice on the verification site.
We’ve often blogged about websites that provide information about doctor behavior and pay, among them ProPublica’s Dollars for Docs. It lists approximately $2.5 billion in payments to doctors, other medical providers and health-care institutions that have been disclosed by 15 pharmaceutical companies since 2009. It can be searched by state and company, and filtered by category and year.
Dollars for Docs shows payments by companies that have made information public, typically under settlement agreements with the government to resolve allegations of improper marketing. ProPublica also has researched company websites for information.
“On each payment record in Dollars for Docs,” according to the site, “you can find details about the drugs each company makes, how it describes the service performed and questions you can ask your doctor about his or her relationship with the companies.”
It’s not as comprehensive as what the law requires CMS to do, but it’s a fine resource, especially in light of the fact that CMS is not really doing what it’s supposed to.