When you visit your doctor, trust is the most important part of the experience. You trust them to diagnose you correctly, treat you with care, and prescribe the medication that is best for your health. However, healthcare is also a massive industry. Sometimes, financial relationships exist between the doctors we see and the companies that make the drugs and medical devices we use.

This is where the CMS Open Payments program comes into play. If you have ever wondered about the financial ties in the healthcare system, this federal database is the tool designed to give you answers.

What is the Open Payments program through the Centers for Medicare & Medicaid Services (CMS)?

In very simple terms, the Open Payments program is a national transparency initiative operated by CMS. The Open Payments program originates from the "Sunshine Act", which was created under the Affordable Care Act (ACA). The Open Payments Program’s primary focus is to make financial relationships between physicians and pharmaceutical and medical device companies visible to the general public.

The CMS Open Payments Program collects information on payments made from pharmaceutical and medical device companies to physicians, physician assistants, nurse practitioners, and teaching hospitals as required by law.

Many of the payments that are recorded for purposes of the Open Payments Program are not considered illegal or inappropriate as the majority of these payments are from standard business-to-business activities such as:

• Consulting fees for a physician to provide his/her expert opinion.

• Research grants to fund clinical research studies.

• Speaking fees for a physician giving a presentation/lecture at a conference on the use of a specific pharmaceutical product.

• Meal and travel expenses to cover the cost of meals while making a sales pitch and the cost of flights to attend a medical conference

Once CMS collects payment data, the Open Payments Program publishes said payment data publicly for anyone… including you… to search for.

Do you ever wonder why it's important for you to know if your physician was given complimentary lunch by a pharmaceutical company? 

There is a financial conflict of interest that exists with many healthcare providers, but generally, they focus on the success of their patients. However, studies have shown that physician behaviors can be influenced at times by financial ties to other companies. As an example, if a doctor received a significant amount of money for giving speeches from Company X and subsequently prescribed that company's very expensive brand drug instead of prescribing the very cheap, equally effective generic drug... 

Using the Open Payments CMS search tool helps you to be an informed patient, by providing you with the entire picture. You may want to use your specialist's payment history as a guide to asking questions of your doctor, should you choose to have surgery or a procedure using a certain product or device, due to that particular company having paid the physician several thousand dollars within the previous twelve months.

How to Use the System

The government has made the CMS Open Payments data very easy to access. You don’t need to be a data scientist or a lawyer to figure it out.

1. Visit the Website: Go to the official Open Payments search tool online.

2. Search: You can type in the name of a doctor, a specific hospital, or even a drug company.

3. Review the Data: The site will show you a profile. You can see the total amount of money received, broken down by year. You can also see why they were paid (e.g., for food, travel, or research).

Improving the Healthcare Conversation

It is important to remember that finding a record in the Open Payments CMS database does not mean your doctor has done anything wrong. Collaboration between doctors and drug companies is often necessary to develop new life-saving treatments. Research requires funding, and innovation requires cooperation.

Nonetheless, transparency plays an important role in creating an honest healthcare environment. The Centers for Medicare and Medicaid Services (“CMS”) Open Payments program provides you with the opportunity to see any financial relationship between your doctors and the companies they may prescribe. This way you can have an open, honest conversation with your doctor.

An essential part of taking charge of your health is doing your due diligence in researching the doctor you are working with every time you get a new medication or are going to have a procedure done. By taking just a few minutes to research the doctor you will be working with, you will gain confidence in the system and the people who are helping you get to better health. Transparency can lead to building trust with your doctor, and trust is an essential component of effective medical practice.