Today’s digital natives are accustomed to accessing information in two or three clicks. But that’s not the case when it comes to physician transparency programs, such as the Open Payments Program established by the Centers for Medicare and Medicaid Services (CMS) as a result of passage of the Physician Payments Sunshine Act. AAOS members who wanted to see what payments were reported about themselves by manufacturers and group purchasing organizations (GPOs) had to complete more than 30 separate steps. The process generally took at least an hour—and even then, it didn’t always work.

The situation was so bad that, at three separate times, CMS, which was responsible for collecting and posting the data, shut down the system completely. The first shutdown lasted 11 days and was triggered when a physician reported that payments attributed to him in the system were actually made to a different doctor with the same name, despite the fact that the two physicians had different addresses, lived in different states, had different middle names, and had different National Provider Identification (NPI) numbers.

The other two shutdowns were single days for “scheduled maintenance upgrades.” As a result, the timelines for physicians to review and dispute data and for industry to make corrections kept changing. The public release date, however, remained Sept. 30, 2014.

Intermingled data
During its investigation into the inaccurate attribution of data, CMS found multiple instances of “intermingled data,” meaning physicians were being linked to medical license numbers or NPI numbers that were not theirs. Nearly a third of the data submitted by manufacturers and GPOs were returned and were not included in the data release.

The errors occurred despite multiple steps in the registration process designed to conclusively identify each physician. For example, as part of the initial registration process, physicians were asked several “Out-of-Wallet” questions, such as the name of the lender for the physician’s mortgage or auto loan, previous employers, and other private data. Through the vetting process, a soft credit inquiry was made to Experian Credit Services and used to verify identity. Only after this process was complete could physicians proceed to the Open Payments data review.

Quoted in a press release, CMS Deputy Administrator and Director of the Center for Program Integrity Shantanu Agrawal, MD, said, “CMS takes data integrity very seriously and took swift action after a physician reported a problem. We have identified the root cause of the problem and have instituted a system fix to prevent similar errors. We strongly encourage physicians to review their records before the deadline and before the data are posted publicly to identify any discrepancies.”

CMS stated that it implemented system fixes to resolve the issue. It also revalidated all data in the system to verify that the physician identifiers used by the applicable manufacturer or GPO are accurate and that all payment records are attributed to a single physician. Finally, it removed incorrect payment transactions and said these data will not be published.

“These invalid payment records have been removed and will be returned to the applicable manufacturer or applicable GPO that submitted them so they can be corrected and resubmitted,” CMS stated. Further, the records identified as “invalid” will not be accessible to the public “until they are corrected by applicable manufacturer or applicable GPOs and the physicians and teaching hospitals have had an opportunity for review and dispute.” The withheld data will not be published until June 2015.

Research data missing
Another problem arose with data concerning research grants made by pharmaceutical companies to doctors through intermediaries, such as contract research organizations. According to ProPublica, an independent, nonprofit online newsroom, some physicians have not been given the opportunity to verify and dispute payments attributed to them, as required by law.

The news was concerning to members of Congress as well as to industry. Sen. Charles Grassley (R-Iowa), one of the main proponents of the law, fumed that “CMS has had more than four years to figure everything out. It’s disappointing and irresponsible that so many basic questions are unresolved at this late stage.”

In response to the CMS announcement, a representative for the pharmaceutical trade organization PhRMA said, “Our companies continue to review the data issues surrounding the recent actions by CMS to remove certain information from Open Payments. Without a full accounting of the rationale behind CMS’ decision, it is difficult to fully understand the ongoing data validation issues.”

Data validation was one of the reasons the American Association of Orthopaedic Surgeons (AAOS), in conjunction with the American Medical Association and more than 100 other medical associations, called on CMS to delay the release of the data. Citing their support for “efforts to increase transparency in the interactions between physicians and industry,” the organizations nonetheless expressed concerns about a number of issues, including proposals for expanding data reporting requirements.

Educational efforts directed to physicians are ongoing. A symposium on the Physician Payment Sunshine Act was held during the Fall Meeting of the AAOS Board of Councilors and Board of Specialty Societies; coverage will be included in next month’s AAOS Now.

Mary Ann Porucznik is managing editor of AAOS Now; Richard N. Peterson, JD, is the AAOS general counsel.