Medicare Transparency Program Is Far From Clear


Context is king, whether you’re telling an amusing anecdote or poring over raw data, and without it, it’s hard to know what to make of anything. A Medicare payment transparency effort may be lacking context, and experts tell me it may be reducing the effectiveness of the program.

The Open Payments program requires drug and device companies to report all payments to doctors and teaching hospitals, and Medicare posts a yearly update June 30. In 2016, for example, drug and device companies made $8.19 billion in payments to doctors and teaching hospitals.

Major questions remain over whether the reported Open Payments data is accurate or detailed enough to provide any real insights to patients or the government, Andrew Furlow, an attorney with Hogan Lovells in New York, told me. “There’s a persistent misconception in some circles that all payments being reported are inherently improper,” he said.

Furlow said a recent New Jersey rule capping payments from drug companies to doctors at $10,000 is an example of the context problem. A press release touting the new rule cited the total amount paid by drug companies to New Jersey doctors as the reason for the cap, he told me.

“This kind of inference is troubling and may call for education at the state level to ensure policy makers understand the data and what it represents,” Furlow said.

Inaccurate data can easily be reported through the Open Payments program, a spokesman for the American Medical Association told me, and there’s little chance that it will be verified and corrected. Physicians have to register with the program to review data and have a chance to dispute inaccurate records.

The Centers for Medicare & Medicaid Services doesn’t validate the data it receives from drug and device companies, and physicians frequently aren’t aware of the reported data, the AMA said.

Only 5.5 percent of physicians registered for the Open Payments program, according to the 2016 data.

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