More Finger Pointing Over Sunshine System Snafus

Further delays in implementing the Open Payments program for disclosing industry financial relationships with prescribers has ignited a blame-game over who is at fault. The Centers for Medicare and Medicaid Services (CMS) is citing inaccurate data from pharma and medical device companies for the latest problems involving erroneous payment attributions.

Manufacturers maintain they fully validate data filings and have to “attest” to its accuracy, and that the latest problems arise partly from constant changes by CMS in data formats and templates.

Everyone is eyeing contractor CGI Federal, which CMS engaged to build the submission portal for the complex data system, evidently before CGI’s debacle in launching the Healthcare.gov insurance exchange a year ago.

Physicians, meanwhile, are livid over the prospect that CMS will release inaccurate payment information, as the agency continues to insist on going live with Open Payments Sept. 30. The latest problems with Open Payment came to light when ProPublica reported on a doctor in Kentucky who examined his payment report and found funds credited to him that actually went to a physician in Florida with the same name. Health care professionals (HCPs) have the opportunity to pre-review their reports and file complaints, a process that has proven to be extremely cumbersome and time-consuming. Physicians have been pressing for CMS to delay the program another six months, but the agency is under intense pressure from Congress to launch on time.

Rejecting reports
To go public  Sept. 30, but reduce release of “inconsistent” data, CMS now plans to “withhold” one-third of submitted payment records, which the agency says is flawed and “intermingled.” Following the disclosure of the doctor data problem, CMS shut down Open Payments from Aug. 3 to Aug. 15 to “resolve a technical issue.” Shantanu Agrawal, CMS deputy administrator and director of the Center for Program Integrity, which has the task of establishing and operating Open Payments, said last week that the agency had identified “the root cause of the problem” and had “instituted a system fix.” Under the new plan, the one-third of submitted data being withheld will not be posted until the next reporting cycle in June 2015.

The main problem seems related to the use of the national provider identifier (NPI) to identify individual HCPs. Unfortunately, the NPI data base often provides differing state licensure numbers and multiple addresses. For Open Payments to work, the program has to be able to distinguish HCPs with similar names and correctly attribute payment information from multiple manufacturers, a task that is the hardest part of building this kind of data system, explains Mark Linver of Huron Life Sciences. The current system appears unable to do this, partly because different pharma companies end up filing reports with differing information, largely because company data may be more accurate and more current than what is in the NPI data base.

Pharma companies are logging into the Open Payments system to see what has been removed and where errors might be, but this involves millions of records, noted John Oroho of Porzio Life Sciences at CBI’s Forum on Transparency and Aggregate Spend this week in Washington, D.C. He observed that the problems with Open Payments appear similar to those experienced by the Healthcare.gov insurance exchange, which could not match personal and financial information of individuals signing up for coverage and prevented insurance companies from identifying and billing new plan members.

Susan Hibbard, transparency senior manager at Boehringer Ingelheim wondered how the CMS data withhold would affect a company’s attestation to the accuracy of its submission.

We should regard the disclosure of limited 2013 data as “a trial run,” commented Ann James of Stanford University, which, along with other academic medical centers, have multiple concerns about Open Payments disclosures. Yet media reports suggesting that academic researchers are coerced by industry payments, she noted, “is a real concern” for maintaining productive research relationships.