The Approaching Sunshine Apocalypse

On September 30, a week from today as I write this, the US government will release the long-anticipated Sunshine Act Open Payments data to the general public. Or at least some of it, maybe two thirds. It’s not clear. What is clear is that Open Payments has gotten off to a rocky start, reminiscent of the snafu with the inauguration of HealthCare.gov last year.

Our story so far: Back in 2011 as part of the Affordable Care Act, aka ObamaCare, measures were put into place to shed light on the here-to-fore undisclosed direct financial dealings between Big Pharma and physicians. All payments, whether in the form of honoraria, ball-point pens, or bagels from Panera were to be accounted for, tallied up, and presented on a web site for the public to peruse starting this September 30. As a concession to the physicians and drug or device companies, there was a period of review this summer (45 days), during which payments could be viewed by physicians and potentially disputed.  Payments disputed after this time period would be marked as undisputed in the database.  Thus it was important for physicians to dispute these payments before the release to the general public (BTW it’s too late now).  I’m not sure how many physicians participated in the review process. Getting into the Open Payments website initially is onerous.  In order to register for the site, two separate processes of authentication are required, during which applicants are challenged to answer questions based on their credit report history (!), as well as answer a series of questions while a timer runs, including providing a subspecialty code which, if you are lucky and have a fast internet connection, you can google just in time before the buzzer runs out.

Having gotten into the system, one can laboriously go through each payment in a spreadsheet and try to ascertain whether or not various payments are legitimate. When I did this I found that, despite providing very specific information in the login process (such as my NPI number), my payment records were mixed in with another physician with my name who practiced in a different state (Florida vs Kentucky) in a different specialty (oncology vs cardiology). Via Charles Orstein and ProPublica this story was published.   This resulted in CMS shutting down the Open Payments website to fix this problem.  The site was shut down for 12 days, from August 3 to August 15. The time allotted for physicians to review their data was extended correspondingly, to September 11.  However, upon reopening the site not only were the mixed up payments gone, but most of the legitimate ones were also missing from the database. CMS then stated that some companies’ data was still being withheld due to data inconsistencies in company submissions. The companies dispute that the problem is theirs, instead blaming the government. The amount of data missing is supposed to be about a third, but, at least in my case, almost all the legitimate payments previously listed in database prior to the closure of the site are now missing.  For example there is no data listed at all from Medtronic, despite payments from them in the database before the “glitch.”  Meanwhile, further glitches shut down the Open Payments system intermittently between August 30 and September 5. Despite all this, the imperfect data is still planned to be released to the public on September 30.

What will the public make of this? Will some consider any payments at all to doctors in the form of food or honoraria a sign of corruption or at least conflict of interest? Will the trivial nature of some of these payments be reassuring to the public? Will the data reveal blockbuster damning revelations about the nature of the relationship between industry and physicians?   Or will the data be just ho-hum?  Who knows? My question is, why release the data now if it is incomplete or questionable? Why stick to this arbitrary timeline? If we are going to supply this data to public, shouldn’t it be as accurate as possible?

I just checked the Open Payments website. It is down again. Not reassuring.