Guidance for clinical faculty on the PPACA "Open Payments" process
The "sunshine provisions" of the Patient Protection and Affordable Care Act (PPACA) require that manufacturers of devices, drugs, and other items that must be prescribed or ordered report their payments to physicians and teaching hospitals. These payment data will be published on the Centers for Medicare and & Medicaid Services (CMS) Open Payments web site, and will represent one segment of a clinical faculty member's digital reputation. It is important that our clinical faculty understand the reporting process and its ramifications, and what they should do to ensure that any payments they are reported as having received are, in fact, correct.
What information is reported to CMS?
Schedule for reporting, review, and posting of data
Registration, review of your payment data, and disputes
How published payment data will be used
How to prepare for the Open Payments process
The Open Payments mobile app
Definitions from the sunshine provisions
Links to additional information
Resources to help physicians register and review payment data:
-- CMS fact sheet for physicians
-- CMS - registration in the Enterprise Identity Management System (first step of registration)
-- CMS - registration in the Open Payments system (second step of registration)
-- CMS - how to nominate a designee to review your payments
-- American Psychiatric Association guide to registration and review (links at bottom of page)
"Payments,” including both cash transactions and transfers of value (such as meals or sponsored travel), that exceed $10. Manufacturers also must report aggregate payments to a single payee over $100 in a calendar year. Payments are reported in the following categories:
- Consulting fees
- Compensation for services other than consulting, including serving as faculty or as a speaker at a non-CME event
- Food and beverage (except when provided buffet-style, at large-scale events where the recipients are not identified)
- Travel and lodging
- Research- these payments should be reported as having been paid to the Rector and Visitors, but may be attributed by the sponsor to the Principal Investigator
- Charitable contributions (e.g., if in lieu of compensation, your earnings were paid to a charitable organization)
- Royalties or licenses
- Current or prospective ownership or investment interest
- Compensation for serving as faculty or as a speaker for an unaccredited and non-certified continuing education program
- Direct compensation from a Manufacturer for serving as faculty or as a speaker for an accredited or certified continuing education program (see SOM document on the sunshine provisions and CME)
- Grants - these payments should be reported as having been paid to the Rector and Visitors, but may be attributed by the sponsor to the Principal Investigator
The data fields that are reported to CMS are described in the Open Payments User Guide for Industry.
- Initial reporting. Applicable Manufacturers submit preliminary payment data on a calendar year basis. For the 2014 reporting year, the deadline for reports to be filed was March 31, 2015.
- Physician review of payment data. Before publication, reported payments to physicians cannot be reviewed by UVA administration. Therefore, physicians are strongly urged to review their preliminary payment data. The window for reviewing and disputing 2014 payments ended on May 20, 2015. To review your own payments data during this period, you must follow this two-step process: first, register for the CMS Enterprise Portal; then, register for the Open Payments system. See "Registering, review of your payment data, and disputes" below for guides to these registration processes. If you registered previously, you may be asked to update your password.
- Correction of errors in the Open Payments database. During the data review period, physicians can dispute one or more of their reported payments. See the CMS dispute and resolution page. The payor has an additional 15 days to correct its information in the CMS database, after the review period has ended. Payments that cannot be resolved will be marked on the CMS web site as "disputed." Note: PPACA includes penalties for companies that under report rather than over report. Some companies are reporting grant/contract payments as having been made to both the Medical Center (which shares the same tax ID as the rest of UVA) and the Principal Investigator of the research project.
- Publication of final reporting data (2014 data were released on June 30, 2015). After the review/correction period, CMS finalizes and posts the data on the Open Payments site. CMS updates the current and previous year’s on-line reports at least once annually after the initial posting.
- Registration in the Enterprise Identity Management System (first step of registration)
- Registration in the Open Payments system (second step of registration)
If you have difficulty registering or logging onto the system, please contact the Office for Research for support in these processes. Disputes are handled within the system itself. The process for disputing and resolving payment data is described in the document " Physician and teaching hospital record review and dispute functions."
If you have been compliant with SOM policy regarding financial disclosure and vendor gifts, you are in good standing institutionally. However, since we expect the data to contain some discrepancies and the final data will become public information, you should attend to what will become part of your digital profile/reputation by reviewing your preliminary payment data on the Open Payments site.
Expect your published payment data to be reviewed by public interest groups, the press, and patients. What may appear to be a large payment to the uninitiated eye may reflect innocuous payments for research or other activities that directly support the missions of the University. Please refer any queries from the press concerning your reported payments to: Health System Public Relations (924-5679; after business hours, 982-1100).
The School of Medicine will perform the following reviews:
- Comparison of CMS payment data to faculty financial disclosures in the SOM on-line system, to ensure that physicians have been disclosing their external financial interests as required by SOM policy and that no additional financial interests or conflicts should be monitored. Only large discrepancies between CMS data and SOM disclosures will result in queries to individual faculty.
- Examination of broad patterns of payments to SOM physicians. For instance, if CMS data suggest that our faculty have been accepting small gifts from manufacturers (contrary to SOM policy), we might bolster our education efforts in this area.
- Familiarize yourself with the program information provided at https://www.cms.gov/OpenPayments/Program-Participants/Physicians-and-Teaching-Hospitals/Physicians-and-Teaching-Hospitals.html.
- Register with CMS and review your payment data.
- Dispute any charges that are not yours. Make sure that your dispute is resolved to your liking.
- Going forward, maintain records of payments and transfers of value that you have received (or will receive), for comparison with preliminary payment data.
CMS has developed a mobile app (click here for iOS version, Android version) to help physicians track, store, and view payments and other transfers of value from Applicable Manufacturers. It cannot be used to review or dispute your payments in the CMS database. See, also, FAQs for the mobile app. If you had downloaded the app previously, check for updates at Google Play or the iTunes.
- “Physicians” – include doctors of medicine, osteopathy, dentistry, dental surgery, podiatry, optometry, and chiropractic medicine. As defined by the law, “physician” includes his/her immediate family members.
- “Covered Products” – drugs, biologicals, devices, and medical supplies reimbursed by Medicare, Medicaid, or Children's Health Insurance Program. Covered drugs and biologicals require a prescription or doctor's authorization to administer. Covered devices and medical supplies require pre-market approval or pre-market notification by the FDA
- “Applicable Manufacturers” must be physically located or conduct activities within the US:
- Type 1 Manufacturers engage in the production, preparation, propagation, compounding, or conversion of a Covered drug, device, biological, or medical supply. Includes distributors or wholesalers that hold title to a covered drug, device, biological or medical supply;
- Type 2 Manufacturers are under common ownership with and provide support the listed activities of a Type 1 Applicable Manufacturer.
- Open Payments program site and source for much of this document: http://www.cms.gov/Regulations-and-Guidance/Legislation/National-Physician-payment-Transparency-Program/index.html
- Open Payments fact sheet for physicians: http://www.cms.gov/Regulations-and-Guidance/Legislation/National-Physician-Payment-Transparency-Program/Downloads/Physician-fact-sheet.pdf.
- Brochure explaining the Open Payments program, for sharing with patients.
- Open Payments FAQs (note subtopics on the left): https://questions.cms.gov/faq.php?id=5005&rtopic=2017.
- AMA toolkit for physicians: http://www.ama-assn.org/ama/pub/advocacy/topics/sunshine-act-and-physician-financial-transparency-reports.page