Why your CRM has to remember when an affiliation was true

What Open Payments is

Under the Physician Payments Sunshine Act, manufacturers of devices, drugs, biologicals and medical supplies covered by Medicare, Medicaid or CHIP must report payments and other transfers of value made to physicians, certain other practitioners and teaching hospitals to CMS. Group purchasing organizations report too. The recipient is either a person or an organization: a physician identified by NPI and state licence, or a teaching hospital that receives Medicare graduate medical education payments.

Covered recipients get a forty-five-day window to review and dispute each transaction before it is published. Publication runs roughly eighteen months after the transaction. And the manufacturer must keep the books, contracts and records sufficient to enable an audit for at least five years from the date of publication, which works out to about six and a half years from the act itself.

The timing problem

Reporting runs months after the interaction. When it does, the transfer of value has to be attributed to the physician as they were at the time: which hospital, which role. A CRM that flattens employment to a single current employer answers with whoever the physician works for today. If Dr Smith moved from Anytown Regional to Anytown University Hospital in the spring, every lunch, sample and education event from the winter is now attributed to the wrong institution, and the historical truth is simply gone from the system that was supposed to hold it.

Three requirements follow, and none of them is optional:

1. An affiliation between a person and an institution needs a start date and an end date.
2. A logged interaction has to be attributable to the affiliation that was current when it happened, not the one that is current when somebody runs the report.
3. A contact record has to survive its employer changing. The person is the same person; the hospital is a dated fact about them.

These look like data-modelling fastidiousness. They are a compliance control. Anyone later tempted to simplify a contact to a single current employer would be removing that control, and would have no way of knowing it from the CRM alone.

A question for your compliance team

The regulation defines an indirect payment as a transfer of value made through a third party where the manufacturer requires, instructs, directs or otherwise causes the third party to provide it, and it exempts a payment only where the manufacturer does not know the recipient's identity. A manufacturer that names the physicians on its account team knows their identity. So before you invite a surgeon who is not your employee into your workspace, ask whether a seat is a transfer of value. We do not know the answer for your company. We do know the question is worth asking first.