Since the April 2013 effective date of the Final Rule implementing the “National Physician Payment Transparency Program: Open Payments” (also known as the federal “Sunshine Law”), CMS has been annually collecting information on drug and medical device manufacturers that meet the definition of an “applicable manufacturer” and certain payments or other transfers of value that these entities make to physicians and teaching hospitals. The Open Payments Program also requires that “applicable manufacturers” and group purchasing organizations (GPOs) disclose annually any ownership or investment interests held in such entities by physicians (or their immediate family members), in addition to reporting information on payments or other transfers of value made to such owners or investors.
The program was designed to further the goals of the Affordable Care Act by increasing transparency into financial relationships between certain healthcare practitioners and manufacturers of medical devices, drugs, biologics, and medical supplies. The Open Payments Program was expanded with the passage of the “SUPPORT for Patients and Communities Act.” Beginning with data collected in 2021, applicable manufacturers and GPOs are now required to report payments and other transfers of value provided by an applicable manufacturer to an expanded list of healthcare professionals, including physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists & anesthesiologist assistants, and certified nurse-midwives, in addition to physicians and teaching hospitals.
On July 13, 2021, the Centers for Medicare and Medicaid Services (CMS) proposed additional changes to the Open Payments Program when it released its 2022 Physician Fee Schedule Proposed Rule. The proposed changes, which would be effective for data collection beginning in CY 2023 and reporting in CY 2024, include the following:
The changes are meant to clarify some of the Open Payments Program reporting requirements, address stakeholder concerns, and improve the utility and quality of the data reported. CMS is formally soliciting feedback via comments on the 2022 Physician Fee Schedule. Comments are due by 5 PM EST on September 13, 2021.