Sunshine Act Reporting : Impact of the Changes to 2021 Requirements

This post is focused on the impact of the new data elements and recipient types, within the CMS Open Payments 2021 spend dataset, due to the related new requirements. We’ll also look at the macro trend line for spend as the US continues to open up interactions that were avoided during the height of COVID concern.  

Overview:

NOTE: All of the numbers and visualizations are brought from Alanda’s CMS Analytics platform, into which we publish five rolling years of Open Payments spend, recipient and taxonomy data. We thought it would be an interesting and useful exercise to utilize the platform to look at the impact of the recent changes, what story was being told by the data, and what we might expect going forward.

Alanda is a software and data company, not a consulting firm specializing in policy or advisory services. As such, our interest in the recent changes to Open Payments reporting requirements are most structural in nature, you’d have to look elsewhere for the impact on policy. The structural changes to the Open Payments requirements as of 2021 spend, which can be found in summary form here, concern three areas:

1. The inclusion of Advanced Practitioners as new covered recipient types.
2. Three new Nature values
   1. Debt Forgiveness
   2. Long term medical supply or device loan
   3. Acquisitions
3. Newly Required Device Identifiers

Advanced Practitioners

Manufacturers were required to report on six new non-physician covered recipient types in 2021 spend, which are couched herein under the term “advanced practitioners”. No changes were made to the original covered recipient types. Before we discuss the Spend, we’ll take a moment to lay out exactly how CMS identifies these advanced practitioners through the Spend record itself, through the Recipient dataset CMS provides, as well as through an adjacent taxonomy file; for the sake of this post, we’ll focus on the Spend and Recipient data.

The Spend Record:

The published Spend records reflect how the manufactures categorized the HCP recipient in the Spend when submitted, as such there are many occasions where the same HCP has been submitted to CMS under more than one Covered Recipient Primary Type. An example of this mixed recording would be a single HCP that was submitted as a Doctor of Osteopathy, Physician Assistant and a Nurse Practitioner, each by different manufacturers. There was 1 HCP submitted under four Types, 372 under three Types and 30209 under two Types.

It wasn’t obvious that any single manufacturer reported the same HCP under two or more Types, which would have been the comical cherry on top, but I did not run analysis on all of the occurrences to determine if it happened or not. Saved for another time.

The Recipient Record:

The Recipient record appears to make its best attempt at bringing order to the conflicting designations found in the Spend records, regarding the new Covered Recipient Primary Types. The Recipient records have a column called “Covered Recipient Profile Type”, to which CMS applies one of three values; Covered Recipient Physician, Covered Recipient Non-Physician Practitioner and the combination Covered Recipient Physician/ Covered Recipient Non-Physician Practitioner.

In my analysis of the data, it appears that any Recipient which was categorized in the Spend as both a Physician and an Advanced Practitioner, received the combination Type.

Keeping all of this in mind, note that it is all a little fungible, telling a fact-based story on the broad points, and like many stories based on true events, subject to a bit of wiggle room in the details.

Where did the Spend go?

The Scatter Plot diagram below shows that Nurse Practitioners and Physician Assistants received most of the Spend by both volume and amount, while the Anesthesiologist Assistants received very little attention.

In the subsequent comparisons below of Physicians vs Advanced Practitioners, the chart on the left show that Advanced Practitioners received approximately 5% of the Spend in 2021, but the chart on the right indicates that the Advanced Practitioners received approximately 29% of the Spend by volume.

Concerning the overall trending of Spend activity, it remains difficult to predict the impact of the inclusion of Advanced Practitioners in the coming years, due largely to the countervailing trend of activity reduction seen from 2017 and before, to 2019.

It is premature to assess how the conflicting trends play out in the coming years, due largely to not yet knowing the lasting impact of COVID on Spend related interactions. Does 2022 Spend activity on physicians rise up from 2021, to get closer to reduction from 2019 in keeping with the trend line? or will COVID’s impact be  long-term to the degree that 2021 is a relatively high watermark for Spend activity?

Type of Manufacturers

One last note regarding Spend on Advanced Practitioners, in our platform we categorize Manufacturers as one of the four Product types, or combinations, derived from the Products reported.  We found that pure Drug companies interacted with Advanced Practitioners most often, and pure Medical Supply companies, the least often.

Drug Manufacturers

Medical Supply Manufacturers

New Nature Values

As stated earlier in this post, there are three new Nature elements in 2021 Spend. The chart below shows the breakdown of Spend for the new Natures, plus Royalty or License, which may be part of the story. Drug and Biopharma companies play almost no part in the Acquisitions related Spend. We’re largely a data and software company, not policy, so this may be obvious to others, but the data could indicate that some of the Spend normally attributed to Royalty and License, has shifted to Acquisitions, which I assume is the intention.

Device Identifiers

The last new item in 2021 Spend, was the addition of Device Identifiers for Device and Medical Supply products. I was curious to see the impact, if any, on the way that involved products would be reported. Aside from the requisite adherence to structure that would come along with the identifiers, would the product diversity increase, decrease or remain relatively the same. 

The column chart below has been filtered to only consider Spend related to Device and Medical Supply products. Across all the years from 2017 through 2021, the number of unique product names reported has continuously reduced, regardless of COVID’s impact. There has been a steady decline of between 6.5% and 9.5% each year, having reduced by 27.4% in unique product names between 2017 and 2021. This trend must slow or stop at some point, but I see no current indication of a change yet.

That’s it for this post, I hope you found it informative and helpful.