How the health figures are made

What Open Payments is

The Physician Payments Sunshine Act requires drug and device manufacturers and group purchasing organizations to report what they give to physicians, teaching hospitals and other practitioners. CMS publishes those reports. Every figure on this hub is what a company reported, not what a doctor earned and not anything a doctor told anyone.

It excludes salary, insurance reimbursement and private-pay work entirely. The totals on this hub come from CMS’s summary by doctor. What the payments were (food and beverage, consulting, royalties) comes from a second CMS file, which groups each doctor’s general payments by the nature of payment the company reported.

When the two CMS files disagree

Every program year’s natures add up to CMS’s national general payments, to the cent. Doctor by doctor, they do not always: across 2019–2025, 7,887 of 5,711,647 doctor-years (0.138%) disagree. In the case we traced, CMS’s summary credits a payment to a different profile than its payment-by-payment record does, and the nature file agrees with the payment record.

The rule has two parts. A doctor’s page shows what the payments were only when those amounts add up to the total printed above them, to the cent and to the payment; otherwise the breakdown is left out. And a load in which more than 0.5% of doctor-years disagree is refused, because a change that large means something moved at CMS or in how we read the file.

Three kinds of payment, never added together

General payments are those made outside a research agreement. Research payments are money for a study, which may pass through a hospital or a university and reach the named doctor in no part. Ownership is a stake in the company held by the doctor or an immediate family member. CMS carries them in separate columns because they are separate things, and this site never sums them.

A disputed payment is still published

A recipient can contest a report. CMS publishes it either way and counts it in the totals, so a total here is a total of reported payments, some of which the recipient says are wrong. Every page that prints a total prints the dispute count beside it.

One record can be two people, or one person two records

CMS identifies a recipient by a profile, and marks profiles it believes belong to the same person. A count of doctors on this site is therefore a count of records, and where CMS holds someone twice the pages say so rather than silently picking one.

What the Medicare plan landscape is

The Medicare Advantage and Part D pages read CMS’s plan landscape file: every plan CMS has approved for a contract year, listed once for each county it is offered in, with its organization, type, premiums, deductible, out-of-pocket limit and star ratings. The pages show the newest contract year CMS has published, and the year is printed on every page rather than put in its address, so the same page shows next year’s plans the day CMS posts them. The file is CMS’s; this site is not Medicare, sells nothing, and does not recommend a plan.

The figures are the ones CMS approved, which CMS says may change as contracts are finalized. Each page gives two dates: the day we retrieved the file, and CMS’s own date for its figures.

A drug-only plan is sold by state, and rated on Part D

CMS lists a stand-alone Part D drug plan once for each state, under “All Counties”, because it is sold across a Part D region rather than county by county. Every county page lists its state’s drug plans separately from its own Medicare Advantage plans and says which is which, and a county’s plan count is its Medicare Advantage plans alone. A drug-only plan has no overall star rating — CMS writes “Not Applicable” — so the rating printed for it is CMS’s Part D summary rating, under that name.

Where CMS gives words, the words are printed

CMS writes “Not Applicable”, “Not Enough Data Available” or “Plan Too New To Be Measured” where a plan has no figure. Those words are printed as CMS wrote them and never turned into a zero. A premium CMS writes in parentheses, ($19.60), is negative — the net of a rebate that buys down the drug premium — and is printed with its minus sign. A $0 premium is the premium CMS gives for the plan’s medical and drug coverage together, or its Part C premium where it gives no combined one.

How CMS’s counties are matched to ours

CMS names a county but gives no county code, so each is matched by name within its state to the Census Bureau’s counties, and every one CMS lists resolves to exactly one page. Four Virginia names — Fairfax, Franklin, Richmond and Roanoke — are both a county and an independent city, and are matched as whichever CMS wrote. CMS lists Connecticut by the eight counties the state used before 2022, which the Census Bureau no longer publishes; those eight pages carry CMS’s geography and say so.

What none of it says

Nothing in this record says a payment was improper, and nothing here says so for it. A payment and a prescription are two records about one identifier; they are printed one after another, each dated and each attributed, and never arranged so that one appears to explain the other.

What this data cannot show

• Open Payments is what manufacturers reported, not what a doctor earned. It excludes salary, insurance reimbursement and private-pay work entirely.
• General, research and ownership payments are three different things and are never added together here. A research payment may pass through an institution and reach the named doctor in no part.
• A payment the recipient disputed is published by CMS either way and counted in the totals, so a total is a total of reported payments, some of which the recipient says are wrong.
• Part D is Medicare Part D and nothing else. A prescriber’s commercial, Medicaid and cash-pay volume is absent, so a small figure here can be a large practice.
• CMS excludes records derived from ten or fewer claims and suppresses values between 1 and 10 within the rows that remain, so a blank is a withheld value and never a zero. CMS states that summing the detail file underestimates the true totals.
• Nothing in either record says a payment influenced a prescription, and nothing here arranges the two so that it appears to.
• A plan’s premiums, deductible and star ratings are what CMS approved for a contract year, and CMS says they are subject to change as contracts are finalized. Every plan figure states its contract year and the date CMS last updated the file.
• A star rating is not always a number: CMS writes “Plan Too New To Be Measured”, “Not Enough Data Available” or “Not Applicable” where it measured none, and those words are printed rather than a zero or an average.
• The plan landscape excludes employer-sponsored plans, Part B only plans and National PACE plans, so a count of plans is a count of what CMS lists for a general audience rather than of every plan that exists.
• The nursing home, hospital and dialysis star ratings are CMS’s own, as published; this site rates nothing, and no share here counts a facility CMS left unrated as rated.
• A nursing home chain is CMS’s grouping of homes under common ownership or management. Staffing is reported by the homes and adjusted by CMS for how much care residents need, and fines and penalties cover CMS’s look-back period only.
• “Worse than the national rate” and “worse than expected” are CMS’s comparisons, made measure by measure: a hospital that reports few measures has few comparisons, and a dialysis facility is compared with what CMS expects for its own patients, not with another facility.

Sources

• Open Payments — payments grouped by physician — Centers for Medicare & Medicaid Services · U.S. Government work, public domain · Updated: Annual
• Open Payments — payments grouped by covered recipient and nature of payment — Centers for Medicare & Medicaid Services · U.S. Government work, public domain · Updated: Annual
• Medicare Part D Prescribers — by provider — Centers for Medicare & Medicaid Services · U.S. Government work, public domain · Updated: Annual
• Medicare Advantage and Part D plan landscape — Centers for Medicare & Medicaid Services · U.S. Government work, public domain · Updated: Annual