September 29, 2014
Centers for Medicare & Medicaid Services (CMS)
Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201
RE: public launch of the Open Payments website
Dear Administrator Tavenner:
We write as a group of pharmaceutical and medical device companies, consumer advocacy and non-profit organizations in follow up to our in-person visit with the Data Sharing and Partnership Group of the Center for Program Integrity on July 14, 2014 to express our continuing support for the Centers for Medicare & Medicaid Services' efforts to implement the transparency reporting requirements of the Physician Payments Sunshine Act.
The Sunshine Act provides important and long overdue tools for understanding the financial relationships between physicians, teaching hospitals and industry, and reflects the growing trend toward transparency in the health care delivery system. As previously communicated in our joint March 19correspondence, we offer this letter to support CMS in its commitment to report timely, complete, and accurate information regarding the transfers of value manufacturers made to physicians and teaching hospitals on the Open Payments website and to also ensure that stakeholders, including consumers, clearly understand the nature and context of the displayed information.
The launch of the website on September 30 is an important first step. However, as CMS has previously signaled publicly, the initial launch will include only about 70 percent of the recipient name and payment data submitted by manufacturers for 2013, and possibly aggregate information on the remainder of the data. This release will put substantial new information in the public domain. However, the partial nature of this release means that all stakeholders will need to be cautious in drawing conclusions from the data. In particular, any comparisons between named individuals will be limited by the possibility that not all transfers of value will have been published in an identifiable form.
We encourage CMS to include a clear and direct description in its public communications about the reasons for why portions of the data are being initially withheld. Based on conversations with officials at CMS, our understanding of the situation is as follows:
Earlier this year, companies sent CMS millions of pieces of data related to payments they had made to doctors and teaching hospitals during the last 5 months of 2013. As required to facilitate accurate identification of doctors, companies submitted several different identifiers in addition to the doctors' names. These included addresses, medical license numbers, and NPIs (national physician identifiers.)
In comparing the names, medical license numbers, and NPI numbers provided by companies with its own databases, CMS identified many cases in which the numbers did not exactly match up. While some of these mismatches were due to errors in what companies submitted, many were simply due to the fact that companies and CMS were working from different databases.
A hypothetical example will make this problem clearer. A company reports paying $100 to Dr. Jones, and lists her medical license number as 779779. In a database used by CMS, the license number for Dr. Jones is listed as H779779. CMS discovered thousands of inconsistencies like this—some of which were trivial, others more significant. In an abundance of caution, the agency flagged these mismatches and withheld the data from release.
It is our hope that over the next several months, CMS will work closely with industry to solve these data inconsistencies so that the complete information can be displayed as quickly as possible.
We remain committed to working with CMS so that consumers and patients are appropriately and fully informed about the financial relationships between their physicians and the pharmaceutical manufacturing and drug device industries. Thank you for your consideration of this request.
Daniel J. Carlat, M.D.
Director, Prescription Project
The Pew Charitable Trusts
Vice President, Chief Ethics & Compliance Officer
Vice President, Chief Responsibility Officer
Senior Director, Global HCP Transparency Reporting
Eli Lilly and Company
Director, Prescription Access and Quality
Senior Policy Analyst