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Open Payments An Explanation of Section 6002 of the Affordable Care Act

Open Payments An Explanation of Section 6002 of the Affordable Care Act. Center for Program Integrity September, 2013.

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Open Payments An Explanation of Section 6002 of the Affordable Care Act

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  1. Open PaymentsAn Explanation of Section 6002 of the Affordable Care Act Center for Program Integrity September, 2013 CMS Disclaimer: This information is a summary of the final rule implementing the Open Payments Program (Medicare, Medicaid, Children's Health Insurance Programs; Transparency Reports and Reporting of Physician Ownership or Investment Interests [CMS-5060-F], codified at 42 CFR Parts 402 and 403) The summary is not intended to take the place of the final rule which is the official source for information on the program.

  2. Agenda • Introduction • Open Payments Overview • Tools & Resources

  3. Industry-Physician Relationships • Collaborations between physicians and the medical industry can be beneficial by promoting discovery and development of new technologies that improve health and/or lower costs. • Financial relationships may also influence professional judgment and conflicts of interest can potentially arise.

  4. Public Policy • Open Payments (or the “Sunshine Act”) implements Section 6002 of the Affordable Care Act, which was finalized in February 2013. • Final Rule: Medicare, Medicaid, Children’s Health Insurance Programs; Transparency Reports and Reporting of Physician Ownership or Investment Interests

  5. Objectives

  6. Some Key Players Industry Covered Recipients

  7. Open Payments at a High Level • Applicable manufacturers of covered products AND entities under common ownership with applicable manufacturers who provide assistance and support are required to: • report annually to CMS • report payments or other transfers of value made to covered recipients and physician owners/investors • report certain ownership or investment interests held by physicians or their immediate family members • Applicable group purchasing organizations are required to: • report annually to CMS • report certain ownership or investment interests held by physician owners or investors and their immediate family members • report payments or other transfers of value to physician owners or investors

  8. Three Types of Reporting Categories

  9. Types of Payments • This program captures payments or other transfers of value: • Paid directly to physicians and teaching hospitals (known as Direct Payments) • Paid indirectly to physicians and teaching hospitals (known as Indirect Payments) • It also collects information on payments designated by physicians or teaching hospitals to be paid to another party (known as Third Party Payments)

  10. Continuing Medical Education Compensation for speaking at a continuing education program is not required to be reported, if all of the following conditions are met: • The program meets the accreditation or certification requirements and standards of the ACCME, AOA, AMA, AAFP or ADA CERP. • The manufacturer does not directly pay the physician speaker. • The manufacturer does not select the physician speaker nor does it provide the third party vendor with a distinct, identifiable set of individuals to be considered as speakers for the accredited or certified continuing education program.

  11. Continuing Medical Education * Must meet all of the conditions in accordance with § 403.904(g)(1) ** Special rules apply in accordance with § 403.904(h)

  12. Program Operations 2 5 Submission & Attestation Industry Applicable Manufactures & GPO’s Publication cms.gov Center for Program Integrity 1 4 Registration Dispute Resolution Covered Recipients Physicians & Teaching Hospitals 6 Audit 3 Review & Dispute

  13. 2013 Program Cycle Industry will: Collect information on payments and other transfers of value, as well as ownership or investment interests held by physicians and their family members Industry will: Register and submit 2013 information to CMS Industry will: Correct disputed information CMS Public Website: 2013 Information Posted Sep 2014 1Q 2014 2Q 2014 August – December 2013 Physicians should: Review your information for accuracy Physicians should: Register with CMS in order to receive notifications and information submitted by the industry Physicians should: Keep track of payments and transfers of value made to you and be mindful of ownership and investment interests held by both you and your immediate family

  14. Stakeholder Outreach • CMS’ goals include: • Creating awareness • Providing useful and easy to understand information • Providing tools that will support stakeholders

  15. Awareness • We are creating awareness about the Open Payments among stakeholders by: • Hosting National Provider Calls • Keeping national professional associations abreast of program developments • Leveraging national publications, Medicare Learning Network and existing CMS contractors • Distributing information using email

  16. Information & Tools CMS has released various information sources and supporting tools about Open Payments including: • Webpage dedicated to stakeholders • Fact Sheets specific to stakeholders • Operational tools for Industry: Guidance documents, submission specifications, teaching hospital list • Continuing Medical Education modules (2) for physicians • Brochure describing Open Payments • Brochure for patients describing Open Payments • Publications in national professional magazines • Help Desk • Mobile Application for Industry and Physicians

  17. Mobile Applications • Two FREE mobile applications to aid physicians and industry in tracking data collected for Open Payments. • Open Payments Mobile for Physicians • Open Payments Mobile for Industry • The applications are available on mobile platforms Apple (iOS) and Android. • They can be used as a personal information collection and storage tool only.

  18. Benefits of Using the App • Provides a tool to track payments and other transfers of value in real-time • Serves as a reference tool during review or information disputes • Allows physician to provide accurate profile information to industry • Minimizes the risk of data mismatches later when submitted by industry • Allows physicians to receive event and payment or transfer of value, and profile information from industry

  19. Exchanging Information is Easy Physician App Industry App Send Profile Information Send Profile Information Send TOV Information

  20. Track & Review Your Information • Physicians should track all interactions they have with industry involving payments or transfers of value to ensure accuracy • Register to receive a preview of the data to be made public • Tools and resources are available to help

  21. Questions • For more information contact the Help Desk at openpayments@cms.hhs.gov or visit us at http://go.cms.gov/openpayments THANK YOU

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