Physicians: Use the Open Payments Portal to Your Advantage

October 5, 2014

The insanity of CMS' Open Payments portal might benefit physicians. The key is a little civil disobedience to demonstrate the true value of physician time.

I was originally against the new CMS Open Payments Portal. I am beginning to see how this insanity might actually benefit physicians, however. As of September 30, CMS began publishing payments from drug and device makers to doctors, dentists, chiropractors, podiatrists, and optometrists for things like promotional speaking, consulting, meals, educational items, and research.  

The idea behind the portal appears plain enough to me: CMS thinks you should be ashamed of yourselves for earning income for the hours you actually work performing consulting, CME speaking engagements, research, or pretty much any other work you might be able to find from drug and device makers.

Understand, most physicians could have picked something other than medicine as a career. A physician's grade point average is typically in the top one percent of his high school and top five percent of his undergraduate school (and physicians don't major in "art appreciation.") After a grueling MCAT exam, physicians are treated to an intensive four-year medical program, three to five years of residency, and perhaps further fellowship training and board certification examinations. Any misstep along the way can be a CED (career-ending decision.) Most physicians could have worked on Wall Street, or have been executives or entrepreneurs. Instead, they chose medicine as a career, not just a profession. That means they need to earn a living, not just heal the sick. Let's check on how the financial end of things are going.

On October 2, Congressional Quarterly reported that Congress isn't likely to tackle overhauling Medicare's physician payment formula during a lame-duck session. If Congress does not act to address the situation in a long-term manner, Congress may have to pass another law temporarily blocking scheduled physician payment cuts. This isn't unusual. The AMA estimates that the 17 patches Congress has passed so far have temporarily prevented more than $170 billion in cuts in physician compensation. Nevertheless, reimbursement to physicians across all payers continues to plummet.

This has led physicians to seek alternative sources of income. CMS now reveals this news in a manner it hopes will be the shocking to the public, and embarrassing to doctors: perhaps 100,000 out of a possible 900,000 physicians, found some way to supplement income, doing part-time work.

Rather than fight CMS, let's tell the full truth. Rather than engage in civil disobedience, let's do exactly what CMS wishes. Here's my advice for physicians.

First, we recruit as many of the 900,000 physicians as we can get; grab a copy of your grocery bill, your electric bill, or one of your childcare items of expense. Then go to a pharmaceutical company and negotiate enough hourly work to pay just that one month's expense. If there aren't enough jobs requiring a medical degree, that's OK. Take a job cutting the grass or sweeping the floors.

The point being, the pharmaceutical company will be required to report paying enough to cover your grocery bills to CMS, which will in turn be required to acknowledge on its Open Payments website, that a physician's time actually has value. CMS can't help but notice, physicians have bills to pay. Earning money for work isn't shameful. When physicians earn money, they use it to put food on their tables and take care of their children. If, as CMS hopes, your patients notice you earned a little money on the side, you can truthfully answer, "It's how I keep the lights on."