Exclusive to Orthopedics This Week
Missing data. Missing dollars.
Centers for Medicare and Medicaid Services’ (CMS) Open Payments System may be so racked with flaws that as much as $800 million or more in payment records are missing.
Furthermore…and this may be an even bigger story…CMS has never taken an action to enforce compliance.
First, the Data Flaws
In October, I downloaded the entirety of all three 2017 Open Payments databases on how much was paid to physicians for research, in ownership granted, and in the broad category of “general” payments, filtered for payments to orthopedists, and started crunching numbers.
I saw two oddities right away.
- Totals for 2017 were $410 million lower than the totals for 2016. The economy, corporate profits, corporate tax benefits, healthcare spending, and general availability of money were all greater in 2017 than in any recent prior year. In the prior two year-to-year periods, the total rose $400 million and then $390 million. Logically, in the absence of some other factor, payments should have risen by about $400 million again. Instead, payment supposedly fell by about that amount.
- According to the database, a certain manufacturer, which is annually one of the top 10 in payments to orthopedists, had zero payments to any physician in 2017. I asked the company why. Their media person said, “[company] filed our 2017 report on March 29, 2018 (2 days before the March 31 deadline). Unfortunately, and unbeknownst to us, CMS had problems with their attestation function, which meant our ultimate approval didn’t go through on their end…. Dozens of other companies were affected as well. CMS has fully acknowledged that the problem was on their end (not ours) so they have begun an outreach program with affected companies…[and] our 2017 data will now be posted in 2019.”
A CMS spokesman said there hadn’t been any such problems, so I asked the company for proof. The company sent me copies of two emails sent by CMS confirming receipt of its general and research data. See the image for the full text of one of these emails. The company’s name is being withheld to avoid singling it out, given that the CMS email confirms that it did submit.
I emailed the CMS spokesperson again and cited what the company had said.
He wrote back: “We reviewed [company’s] communications with the Open Payments teams during and after the Program Year 2017 submission window and have found nothing resembling the alleged claims or other information you describe. We believe our CMS response is a fair and accurate assessment of the situation…as we close out this request.”
The email from CMS also said, “CMS has not conducted any outreach efforts related to the timely submission of Program Year 2017 data at this time.”
In other words, that’s their story, they’re sticking to it, and stop asking.
CMS announced in mid-November that it will publish a “refresh” of the Open Payments data in January 2019.
