A blog by attorneys for anyone interested in or affected by The Sunshine Act.

Learning Curve: CMS Posts 2013 Data

October 10, 2014
Ruselle W. Robinson

CMS held to its schedule and released the 2013 Sunshine Act data on September 30, 2014.  CMS also published a summary of the Sunshine Act/Open Payments data that held a few surprises.  Here’s what we know so far (all of the numbers are rounded):

  1. The total value of the data reported by CMS was $3.5 billion. Keep in mind that only five months of 2013 data were collected and published.  Extrapolating to a full calendar year, the total  value of the 2013 payments would have been $8.4 billion.
  2. Of the $3.5 billion, only $1.3 billion went to physicians or teaching hospitals identified in the posting. CMS de-identified the recipients of another $2.2 billion, or 63% of the total value of reported payments.  CMS de-identified the recipients because of concerns about whether the submissions were accurate.  CMS expects to fully identify the physician and teaching hospital recipients in 2015 after the affected applicable manufacturers and group purchasing organizations report corrected data.
  3. The number of records submitted totaled 4.4 million. Of those, 1.7 million, or nearly 40%, were de-identified by CMS.
  4. Only 26,000 physicians registered with CMS, which was less that 5% of the physicians who were reported as recipients of 2013 payments. Teaching hospitals did better, with 405 registered out of 1360 reported as recipients of 2013 payments, or 30%.
  5. Of the 4.4 million records submitted, only 12,579 (an exact number) were disputed by registered physicians and teaching hospitals. Most of the disputes, 9000, were not resolved through negotiation and CMS posted those records on its website as disputed, but not resolved.

The fact sheet can be found here:   https://www.cms.gov/OpenPayments/Downloads/Fact-Sheet-Sept-30-2014-Published-Data.pdf

The CMS website for accessing 2013 data can be found here:  http://www.cms.gov/OpenPayments/index.html

Here are my thoughts on the first posting of Sunshine Act/Open Payments data:

First:  This year clearly was a trial run.  In the end, CMS posted partial data for a partial year.  Few physicians bothered to register to view their data.  Time frames for registering, submitting data, and engaging in dispute and resolution felt compressed, and errors in the submitted data quickly surfaced   By the time 2014 data is posted in mid-2015, CMS will have had many months to iron out the issues that arose this year.

Second:  CMS chose to protect the public data’s  integrity by not posting fully identified records that contained incorrect information.  Although scattered press reports emerged after September 30th that a few of the posted records were inaccurate, those reports were few in number.  So the quality of the posted data is high.

Third:  We won’t know the full impact of the Sunshine Act data postings until we have gone through several cycles.  Commentators have speculated that government officials will use the data for enforcement purposes, and that attorneys will mine the data to support pending claims. No one knows whether any of that will come to pass.  Nor do we know whether the Sunshine Act will achieve its primary policy goal:  the weeding out of relationships between industry and physicians that encourage wasteful healthcare spending.  We will need more than one year of data to assess whether CMS is meeting its goal.

I will keep you up-to-date on developments as they unfold.

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