A mix-up of information about two physicians with the same name in different states has opened a window on wide-ranging technical problems the CMS is facing with its Open Payments website reporting industry payments to doctors and teaching hospitals.
Registration for the system, which was scheduled to be publicly accessible Sept. 30, was temporarily suspended last week
after a Kentucky doctor discovered that his data had been commingled with data on another doctor with the same name. The site that was shut down had been open only to healthcare providers since last month. It allowed them to check the information that manufacturers were reporting about them and dispute any errors.
But this isn't the only problem physicians
, drug companies and medical-device manufacturers
have had with the website, which was mandated by the Physician Payments Sunshine Act section of the Patient Protection and Affordable Care Act. Many doctors and medical groups have groused about difficulties signing up for the website, correcting erroneous data and uploading data to the website. It appears that one faulty tool has been shared between the Open Payments website and the government's HealthCare.gov
insurance exchange website. And the website's tough privacy protections make registering a long and onerous process.
The CMS declined to comment for this article.
The delay was triggered when Dr. David Mann, a Kentucky electrophysiologist
registered to the website and discovered that payments data from another Dr. David Mann in Florida had been attributed to him.
This prompted the CMS to temporarily suspend registration to the website. According to a CMS spokesman, the manufacturer reporting the information to the website provided the correct name, address and national provider identifier number but the wrong state medical license, which belonged to another physician with the same name. That caused the pair's data to be combined.
The agency said it thinks the problem is limited, though there is another report
of this happening.
But providers' complaints about the Open Payments website are broader, ranging from the log-in experience to the usability of the website.
Dr. Nate Selden, president-elect of the Congress of Neurological Surgeons, called the registration process “virtually impossible.” His group previously had signed a July 28 letter sent to the CMS asking for changes to the registration process. Twenty-six medical and industry groups signed the letter. “It's either shockingly bad or intentionally obstructive,” he said in an interview.
Dr. John Ratliff, who signed the letter on behalf of the American Association of Neurological Surgeons, agreed with Selden. “I think they say it takes 15 minutes. It probably took me two or three hours by the time I got through the entire process,” he told Modern Healthcare.
The registration process is composed of two stages—an initial registration with the CMS website via a tool called EIDM, and a second stage via the Open Payments website. Both Selden and Ratliff described frustration with the requests made by the website.
“The hardest thing for me was being kicked out of the system time and time again,” Ratliff said. “The website would go down, or I would input information and the website would not move me to the next page on the script.”
At one point, Selden said, the website asks the doctor to find a specialty number. For doctors who don't know, the website provides a link to a 112-page document. From there, the doctor has to go to the appendix of that document, which features another link to another document. There, the codes can be retrieved. Despite the time-consuming requests, the website locks users out after 15 minutes of inaction.
The website also verifies identity through personal questions, such as “What was your last bank loan?,” crosschecked with the Experian credit reporting system. But that system runs into trouble if the doctor has anti-fraud protection, Selden said. “That's just (two) of 40 steps to get in,” Selden concluded.
According to a presentation from the CMS (PDF)
, the first part of the registration process is handled by a tool called EIDM.
EIDM was also the tool used for registration to HealthCare.gov. In October 2013 testimony, then-Optum Vice President Andy Slavitt, who is now the CMS' principal deputy administrator, said that EIDM had been used with two other CMS applications besides HealthCare.gov.
The EIDM tool has been scrapped for HealthCare.gov, according to news reports in Wired
and the Wall Street Journal
. Developers, imported from Silicon Valley, bemoaned the EIDM's onerous registration requirements.
The bad experiences consumers had registering for HealthCare.gov last fall are similar to those doctors experienced registering for the Open Payments website. Users complained
of delays and crashes wiping out their work.
The user experience, doctors say, didn't get better once they actually made it onto the Open Payments website. A doctor without any reported industry payments would receive
an “error” message, saying, “There are no results that match the specified search criteria.”
Selden said the payments listed for him on the website were erroneous. On top of that, he found the website tools to dispute the information were poorly designed. “All the action buttons are off-screen to the right on any normal-sized computer screen and browser,” he said. “You can see the data and look at the data, but it's counterintuitive to figure out how to get to the action items and file your own response.”
Once he did file his complaint disputing the erroneous data, the manufacturer contacted him directly rather than going through the Open Payments website. The website shows only acceptance or denial of the request. “I believe they cannot give their reasoning for denial on the website,” Selden said.
Doctors aren't the only ones with complaints about the website. John Murphy, assistant general counsel for the Pharmaceutical Research and Manufacturers of America, said that his group's members had many problems uploading data, though those problems largely had been resolved.
“Throughout the implementation phase, our companies experienced a lot of technical trouble,” he said. The whole process was “rushed,” he said, and the problems demonstrate that.
The CMS has said it would adjust the review and dispute period
, which began July 14 and ends Aug. 27, based on each day the system is offline.
“We don't know if that means there will be a delay in the launch of the entire website,” Dr. Daniel Carlat, director of the Prescription Project at the Pew Charitable Trusts, said last week.
This is not the first time the Open Payments system has faced delays or controversy. The Sunshine Act originally required data collection to begin in January 2012, but manufacturers began collecting data in August 2013. In addition, the CMS missed its own deadline to issue the final rule on the Sunshine Act rules by several months. The final rule was eventually issued in February 2013.
The delays have frustrated Sens. Chuck Grassley (R-Iowa) and Herb Kohl (D-Wis.), who championed the legislation. While Grassley said the most recent delays were disappointing, he agreed that there should be adequate time for providers to review and correct information included in the database.
“I'll take CMS at its word that this is a minor problem and that no delay in launching the program is necessary,” he said in a written statement. “Covered entities and providers should continue to work with CMS to make sure the program operates as intended. This is valuable information that should be available to the public.”--Jaimy Lee contributed to this article.Follow Darius Tahir on Twitter: @dariustahir