How to Use the Open Payments Database in Your Compliance Program

A quick riddle for you. What totaled $12.59 billion over the course of 14 million transactions?  The answer: payments made to physicians and teaching hospitals in 2022 from industries such as medical device and pharmaceutical companies.

This data is available through the Centers for Medicare and Medicaid Services (CMS) Open Payments database.

What is the Open Payments Program?

According to CMS, the Open Payments program is a national disclosure program that promotes a more transparent and accountable health care system. Open Payments houses a publicly accessible database of payments that reporting entities (including drug and medical device companies) make to covered recipients like physicians. CMS notes that they do not comment on what relationships may be beneficial or potential conflicts of interest. CMS publishes the data attested to by reporting entities. The data is open to individual interpretation.

Anyone could go to the database and look up any licensed clinician in the country to see what payments or in-kind transactions they received in 2022 or any other previous year. Because the data is public, different individuals, including compliance officers, monitor the data as a part of their conflict of interest programs.

Analyzing Cardiologist Payments

Not all the analysis is performed by compliance programs. For example, one study in a cardiology medical journal assessed payments made to cardiologists.

Their study concluded that even though most cardiologists (approximately 76% of all cardiologists) accepted some payments, the total amounts were relatively small (under $10,000). However, they did identify 110 cardiologists who accepted payments of over $1 million in a year.

Some patients might want to know why and from whom their cardiologist accepted over $1 million, as that amount of money might influence their medical decision making on care such as prescription medication or medical device use.

In this study, the top three categories for payments made to cardiologists included:

• • Speaker fees (40.8%)
  • Consulting fees (19.0%)
  • Food and beverage (13.1%)

Payments made to physicians should not automatically be assumed to be untoward, but many studies have clearly shown that payments from industry do influence physician behavior.

If such payments did not influence physician behavior, many pharmaceutical and device companies would need to explain to their governing boards and shareholders why certain expenditures in these areas are so high if they are not getting a return on their ‘investment.’ Of course, such payments could be truly altruistic, but if you believe that is true in all cases, I have a bridge to sell you. There are not very many for-profit pharmaceutical or medical-device companies that exist purely for altruistic purposes.  They exist to make a profit.

How Do Payments Affect Physician Decision Making?

Watch dog journalist groups also mine this data and come up with some interesting findings.  One such group is Pro-Publica. They have followed the data for many years under their “Dollars for Docs” initiative. For one year, they identified a neurosurgeon who received $28.9 million in royalty or license payments. Such payments are likely for a device he helped design. And no doubt, most of us would appreciate neurosurgeons being involved in the design and improvement of medical devices. The payments, however, could influence the neurosurgeon’s decision making. It is also possible that the device the neurosurgeon created is the best on the market and that is why royalty payments are so high. But if you are that neurosurgeon’s patient, wouldn’t you want to know that his medical decision making is based on what is best for you as a patient?

These scenarios raise an avalanche of questions. What if the neurosurgeon sits on a committee of a large health system that is deciding which medical device is approved to use across multiple hospitals? Should the neurosurgeon recuse himself from such decisions? Should royalties not be paid to the surgeon for the surgeries in which he (or the hospitals he works in) uses the devices so there is no direct financial incentive for him to use the device for which he receives royalty payments? And wouldn’t a compliance program want to review the physician payments so that potential conflicts of interest can be recognized and managed to ensure medical decisions are made based on the patients’ best interests and not influenced by financial or in-kind transactions?

Scrutinizing Promotional Speaker Programs

Another category that can raise concerns for compliance officers is “promotional speaking.” In one year, a psychiatrist received $639,000 in speaker fees along with $127,000 in travel expenses. When digging a little deeper, the data identifies certain drugs were related to his speaking fees. Again, the data alone does not automatically mean there is something untoward going on. But a patient or compliance officer might want to assess whether there is a correlation between payments for speaking about certain drugs and prescribing patterns. For example, did the physician’s prescribing patterns change significantly after they began speaking about the product?

This scenario is one of the reasons the U.S. Department of Health and Human Services Office of Inspector General (OIG) has expressed concerns with speaker programs. In November 2020, the OIG issued a Special Fraud Alert about Speaker Programs. Most organizational conflicts of interest programs will assess, through the CMS Open Payments database, speaker program payments received by any physicians within their organization. The Special Fraud Alert outlines some possible red flags to be aware of when assessing clinicians’ involvement in speaker programs.

Open Payments Database: A Resource for Compliance Officers

The CMS Open Payments database contains millions of records and a lot of helpful information for compliance and conflict of interest programs. Categories include royalty payments, speaker fees, travel and food/beverage to name just a few.

If compliance programs have not reviewed the latest data that is available (2022), now might be a good time to do so.

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