Shifting deadlines and timelines have afflicted the website for more than a year. In an August 2013 presentation, the CMS said registration for the website would start in the first quarter of 2014. Then, in a June 2014 presentation to educate physicians on registering for the website, the agency said that the registration period would open sometime in July. Physicians finally were able to register for both legs of the CMS' process starting July 14.
Doctors using the website to examine the accuracy of their data have faced a number of errors. For example, a registration guide put out by Stanford University described an error called “looping,” in which users would find themselves moving a few steps backwards in the registration process for no apparent reason. “Make sure you get to the confirmation page,” the guide advises.
The CMS' estimates for usage of the website shifted over time. Initially, the agency estimated that 448,850 physicians would take three hours each to register for the website, and that 224,425 would dispute information. But after a September 2013 comment letter from Pew Charitable Trusts, the agency revised down its estimates in all three categories—that only 224,425 physicians would take 30 minutes each to register, of which 10,000 would dispute information. Another CMS estimate kept the 224,425 physician count but increased the per-physician registration time to seven hours each.
The CMS said the majority of physicians have taken under 30 minutes, though an agency representative said the CMS does not yet have data on how many registered or disputed data.
“It worries me that CMS doesn't have its act together, frankly,” said Stefanie Doebler, special counsel for Covington & Burling's healthcare and food and drug practice groups. “It doesn't bode well.”
She thinks the agency was too focused the incoming data, and what should be included, and ignored stakeholder comments that it should examine how the website would be built. “They let the website slide,” she said.
The timeline for building the website was quite aggressive. In a September 2012 Senate hearing, a representative from pharmaceutical firm Eli Lilly & Co. said building its payments disclosure website—which disclosed 1.1 million transactions involving 102,000 doctors in 2011—took 23 months.
“It's not an easy process. There's a huge amount of data,” Doebler said. And the CMS' website will handle much more data involving more manufacturers and physicians. The CMS has not offered a preview of the website to manufacturers, which worries her even more.
Complaints about the process for disputing data are widespread. Jonathan Eisenberg, an attorney with law firm General Counsel, said the only options given to data submitters in a dispute are to change the entry and resubmit, or to say no change is necessary. “They did not anticipate in designing the screens that someone might need to delete an entry which is just wrong,” he said. Deletion of data requires navigating back to a previous page.
But such back-end issues won't necessarily affect the general public's experiences on the website. Bill Kramer, co-chair of the Consumer-Purchaser Alliance, a not-for-profit that promotes healthcare performance measurement, said he expects the Open Payments website to “be helpful for both consumers and employers by identifying improper influence” on physicians.
Early rollouts of previous data-transparency websites from CMS – like its Physician Compare or Medicare payment data – have been confusing for consumers, at first, Kramer said, because they simply dumped the data on users. “It can't just be raw data even if it's easily searchable,” he said. “Simplifying the information is important.”
That's why he anticipates that, at least for the first iterations of the website, other organizations will have to interpret the data for the general public. “The key is to have a commitment to improving the accuracy and comprehensiveness and usability of the data,” he said. “We should look at this version as 1.0.”
