Today, RevCycle Intelligence, an online news resource for the insurance industry, posted an article by Ryan McAskill citing concerns from both the CME Coalition and the American Medical Association (AMA) regarding the Centers for Medicare and Medicaid Services' (CMS) recent guidelines for the Sunshine Act. "[CME Coalition Senior Advisor Andy Rosenberg said] that there is nothing in the CMS guidance that undermines the notion that an unrestricted CME grant remains unrestricted. Because of this, if a CME provider has full discretion over physician faculty, speakers and attendees, this still does not meet the definition of indirect payment and is not reportable." However, reading the agency's example of "reportable payments" runs contrary to it's earlier final rule.
An update to the Open Payment database clouds requirements for reporting data to continuing medical education activities.The Sunshine Act and Open Payment database continues to be a controversial entity. Since it was launched in September, a number of organizations have come out to express concern over the system. This stems from the database being incomplete and thousands of records still being challenged by physicians when it went live. It does contain 4.4 million payments valued at nearly $3.5 billion attributed to 546,000 individual physicians and almost 1,360 teaching hospitals.
Recently, a Journal of the American Medical Association article called for patience with the database that just needed to get over a “bad start.” The reason for this is that the transparency it provides will be a positive when it is complete
This week, another update to the open payment database has been announced by the Centers for Medicare and Medicaid Services (CMS), and again it comes with confusion. The update to the website clarifies when manufactured are required to report information about payments made to accredited continuing medical education (CME) activities. Back in July, CMS proposed eliminating the “CME exclusion” and a final rule in October affirmed that policy.
The new guidance covers certain payments that manufactures and group purchasing organization give to continuing medical education suppliers, which pass some of that to doctors as speaking fees. CMS describes it as follows:
“Starting in 2016, when an applicable manufacturer provides an indirect payment or other transfer of value to a continuing education organization for a continuing education event to physicians, and knows or finds out the identity of the physician attendees/speakers within the reporting year or by the end of the second quarter of the following reporting year, that payment must be reported to CMS in 2017.”
However, this seems to contradict the final rule that stated payments were not reportable, regardless if the applicable manufacturer or applicable GPO learns the identity of the covered recipient during the reporting year.
You are not alone if you are confused. The CME Coalition, a 30 plus member organization representing a broad collection of continuing medical education providers, issued a statement following the update, asking for further clarification.
“The CME Coalition is in the process of digesting this new guidance, but at first read, it appears to us that some of it is inconsistent with the final regulations and CMS’s own statements in the Final Rule,” stated CME Coalition Senior Advisor Andrew Rosenberg. “We believe this creates the need for further clarification, which we will be seeking on behalf of our members.”
He added that there is nothing in the CMS guidance that undermines the notion that an unrestricted CME grant remains unrestricted. Because of this, if a CME provider has full discretion over physician faculty, speakers and attendees, his still does not meet the definition of indirect payment and is not reportable.