Healthcare Transparency: A Simple Guide to CMS Open Payments
- venops431
- Mar 17
- 3 min read
When it comes to healthcare, trust is a key component. When your physician prescribes a new medication or suggests you use a certain kind of medical device, you want to feel confident that their recommendation is based entirely on what is in your best interest. You would never want a physician's medical decision to be influenced by an ulterior financial motive.
To help maintain that level of trust and create full transparency, the government created an important transparency initiative. Let's detail exactly what this initiative is, how it operates, and how you can use it as a tool to better understand your healthcare.
What is Open Payments CMS?
Open Payments CMS is a national transparency system managed and operated by the Centers for Medicare & Medicaid Services (CMS) in the US. The objective of the program is to improve transparency around financial transactions that exist between the healthcare sector (including pharmaceutical industry and manufacturers of medical devices) and individual healthcare providers (including physicians and teaching hospitals).
As part of this law (P.L. 111-148, Sec. 6002), companies that manufacture pharmaceuticals and medical devices must report to the government any and all transfers of value made to medical professionals. CMS uses a Content Management System, often referred to as an Open Payments CMS, to support the gathering, organization and publication of the hundreds of thousands of records that come from the Open Payments program.
What is Changing Hands and Type of Money Payment?
When someone hears the phrase Open Payment to Providers, the first thing that they may think of is that it relates to shady business or bribes; but the reality is that most of these types of financial relationships are legal, and ultimately help drive advances in medicine.
An Open Payment to Providers can be defined as being in one of several categories, including:
Research Grant: Many pharmaceutical companies employ physicians to conduct clinical research to evaluate the safety and effectiveness of new drugs.
Consulting Fees: Many experienced physicians consult with other physicians and provide their opinion on how to best design and manufacture a new medical device.
Travel & Education: Companies sometimes pay for the physician’s travel expenses when attending a medical conference to share information about current treatment options.
Food & Beverages: On occasion, drug representatives or other health-related professionals will buy the physician and staff lunch while they discuss a new medication.
Although these payment types are all standard practice, making any of these payments “open” provides public accountability for their existence so that no one can hide these payments from the public.
Where Do You Find This Information?
The nice thing about this program is that the details are not kept in a hidden government archive/file. This information can be accessed by you free of charge, 24 hours and 7 days a week.
All of the data is held within the Open Payments Database. The Open Payments Database is a public and user-friendly web-based application that anyone can use to obtain the required information. Simply enter your physician’s name, the hospital name or individual clinic name, and click search.
Once you have entered the required information in the Open Payments Database, you will receive an immediate response containing a detailed profile of the physician. The Open Payments Database will show you how much compensation the physician received from each entity, from what organization/individual the funds came from, and for what purpose the funds were provided to the physician. Using this information will provide a patient with the necessary information to ask more informed questions.
Why Should You Care? If patients are given access to this type of information, they will have more confidence and fewer fears about their own health care. If you see your doctor writing prescriptions for a particular type of drug, then you will have the ability to review the available information on the company that manufactured the drug. You can also ask your doctor directly (and openly) why they chose this particular treatment for you.
The CMS Open Payments Program is not designed to punish physicians but rather to protect patients. The CMS Open Payments Program will produce an open, honest, and fair healthcare system where transparency becomes the norm rather than the exception. Ultimately, when we have access to and can review the information regarding our physician's financial relationships with drug manufacturers, we can trust our medical care.
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