The 19 natures of payment, explained
CMS sorts every payment into one of 19 categories. Knowing which is which is the difference between reading the data and misreading it.
Every record in Open Payments carries a “nature of payment”. It is the single most important field in the dataset and the one most often ignored. Two doctors with identical totals can have entirely different relationships with industry.
The small stuff
Food and Beverage is by a wide margin the most common category. It is the sandwich lunch a rep brings to a clinic, valued per head. A physician who never asked for it and ate one slice of pizza still appears. Most doctors in the database are here and nowhere else.
Gift, Entertainment and Education are similar in scale — textbooks, anatomical models, reprints, the occasional event.
The professional-services categories
Consulting Fee is paid for advisory work: sitting on a board, reviewing a trial protocol, advising on a device design. Honoraria is a fee for a specific piece of intellectual work.
Four separate categories cover speaking, which is why speaking money is easy to undercount:
- Compensation for services other than consulting, including serving as faculty or speaker outside a continuing education programme
- Compensation for serving as faculty or speaker for a medical education programme
- Compensation for a non-accredited continuing education programme (used in earlier program years)
- Compensation for an accredited continuing education programme (used in earlier program years)
Speaker-bureau work sits mostly in the first two. These are the payments that generate the most scrutiny, because the physician is being paid to talk about a product to other prescribers.
Travel and Lodging
Flights and hotels, usually attached to an advisory board or an investigator meeting. Frequently large in dollar terms and frequently misread as personal enrichment when it is reimbursement.
The categories that signal something different
Royalty or License means the physician invented something. A surgeon who designed an implant earns a royalty on every unit sold. These figures can be very large and represent intellectual property income, not marketing spend.
Current or prospective ownership or investment interest means equity. This is the strongest financial tie in the dataset and is reported separately by CMS.
Grant and research payments usually flow to the institution, not the individual, even though a named physician appears as the principal investigator.
The rare ones
Charitable Contribution, Debt forgiveness, Space rental or facility fees (teaching hospitals only), Long term medical supply or device loan, and Acquisitions together make up a tiny fraction of records.
How to read a profile
Look at the category mix before the total. A $9,000 total that is 95% food is a doctor who works somewhere reps visit. A $9,000 total that is one consulting fee is a professional relationship. Neither is wrongdoing — but they are not the same fact.