Open Payments Data in Context
Open Payments Data in Context
Open Payments gives the public more information about the financial relationships between physicians and teaching hospitals and applicable manufacturers and GPOs. Specifically, the program:
- Encourages transparency about these financial ties
- Provides information on the nature and extent of the relationships
- Helps to identify relationships that can both lead to the development of beneficial new technologies and wasteful healthcare spending
- Helps to prevent inappropriate influence on research, education and clinical decision making
Open Payments means different things to different people and audiences.
For patients, consumers, and the public, Open Payments can be used to learn about the relationships between physicians and applicable manufacturers and GPOs. We encourage patients to discuss these relationships with their health care providers.
For physicians and teaching hospital representatives, reviewing the data reported about you in the Open Payments system can ensure that this information is accurate. You can also:
- Use the information reported about you to plan for questions from patients
For applicable manufacturers and GPOs, Open Payments requires that you:
- Annually report certain financial data to us
- Validate and attest to the accuracy of the data you report
- Review and correct data that physicians or teaching hospitals say is wrong
For researchers, Open Payments offers access to a complete national dataset that can be:
Open Payments is the only national resource of its type for beneficiaries, consumers, physicians and industry.
Open Payments does not identify which financial relationships are beneficial or which may cause conflicts of interest.
The National Academy of Medicine defines a conflict of interest as “a set of circumstance that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest.”1 A 2009 report found “[t]he primary goals of medicine include improving health by providing beneficial care to patients, conducting valid research, and offering excellent medical education… The problem of conflict of interest arises because in some circumstances in modern medicine these goals and obligations are at risk of being compromised by the undue pursuit of financial gain or other secondary interests.”1
Sharing information about financial relationships alone is not enough to decide whether they’re beneficial or improper. Just because there are financial ties doesn’t mean that anyone is doing anything wrong. Transparency will shed light on the nature and extent of these financial relationships and will hopefully discourage the development of inappropriate relationships. Given the complexity of disclosure and the importance of discouraging inappropriate relationships without harming beneficial ones, CMS has worked closely with stakeholders to better understand the current scope of the interactions between physicians, teaching hospitals, and industry manufacturers.
CMS has an impartial role in Open Payments.
CMS’s role is to collect and publish information from applicable manufacturers and GPOs about payments and transfers of value that they make to physicians and teaching hospitals.
Applicable manufacturers and GPOs report each form of payment or transfer of value made, including:
- Anything of value, (cash or cash equivalent form, given by a company to a physician or teaching hospital).
- The nature of each payment. These nature of payment categories were established in Section 1128G(a)(1)(A)(vi) of the Affordable Care Act.
There are definitions and examples of the natures of payment to help the public better understand the context of financial transactions between the companies that make payments and those who receive them.
We have heard from stakeholders that additional context for the information would be useful to consumers. Based on this recommendation applicable manufacturers and GPOs may voluntarily report contextual information about each payment or transfer of value when they submit payment records in the Open Payments system. This information can be found using the Open Payments search tool.
What you should keep in mind when you review Open Payments data
- Small payments or other transfers of value, defined by the law as less than $10, don’t need to be reported. One exception to the law is when the total annual value of payments or other transfers of value provided to a physician or teaching hospital by a single applicable manufacturer or GPO is more than $100.
- If a physician or teaching hospital asks an applicable manufacturer to donate to a charity a payment or other transfer of value they would’ve been paid, the applicable manufacturer must report the payment in the name of the physician or teaching hospital and provide the name of the charity that received the payment. But, if a physician or teaching hospital decides not to accept the payment or other transfer of value and doesn’t request that it be directed to another individual or entity, then the payment or other transfer of value that was offered by the applicable manufacturer doesn’t need to be reported. In this situation, there is nothing to report because no reportable payment or other transfer of value was made to a physician or teaching hospital or to an individual or entity at the request of or designated on behalf of a physician or teaching hospital.
- Applicable manufacturers and GPOs must report certain information regarding the ownership or investment interests held by physicians or the immediate family members of these physicians. Immediate family member means any of the following:
- Natural or adoptive parent, child, or sibling
- Stepparent, stepchild, stepbrother, or stepsister
- Father-, mother-, daughter-, son-, brother-, or sister-in-law
- Grandparent or grandchild
- Spouse of a grandparent or grandchild
For an overview of the entire program, read How Open Payments works and the glossary and acronyms. To learn more about the data and how it’s collected, see the Data Overview or explore the data yourself.
1Conflict of interest in medical research, education, and practice / Bernard Lo and Marilyn J. Field, editors ; Committee on Conflict of Interest in Medical Research, Education, and Practice, Board on Health Sciences Policy.