Today’s headlines include coverage of the debut of the Open Payments database, a federal information trove designed to shed light on the financial connections between physicians and the drug and medical device industry. Kaiser Health News: As Payments Database Debuts, Doctors Urge CautionKaiser Health News staff writer Shefali Luthra reports: “A federal database unveiled Tuesday afternoon details 4.4 million payments from pharmaceutical and medical technology companies to doctors and teaching hospitals, sparking concerns that consumers might misinterpret the information” (Luthra, 10/1). Read the story.Kaiser Health News: ‘The Health Care System Falls Apart When You’re A Complex Patient’Kaiser Health News staff writer Lisa Gillespie reports: “Jeffrey Brenner doesn’t believe in blaming a person for showing up at an emergency room for a cold or an ear infection, even if the illness could have been treated in a doctor’s office at much lower cost. Instead, he faults the health care system, and he wants to prove that if providers, employers and insurers work together more effectively, that person will stop going to the ER” (Gillespie, 10/1). Read the interview.The New York Times: U.S. Cannot Subsidize Health Plans In States With No Marketplace, A Judge RulesA federal district judge in Oklahoma dealt a blow to the Affordable Care Act on Tuesday, ruling that the federal government could not subsidize health insurance in three dozen states that refused to establish their own marketplaces. This appears to increase the likelihood that the Supreme Court will ultimately resolve the issue (Pear, 9/30).The Wall Street Journal: Federal Judge Rules Against Some Affordable Health Care SubsidiesA federal judge in Oklahoma ruled that subsidies under the Affordable Care Act can’t go to consumers who obtained health coverage through a federal exchange. The decision adds to a mix of rulings on whether consumers in states relying on the federal marketplace are legally entitled to subsidies, a question that many expect will wind up before the U.S. Supreme Court. Two U.S. appeals courts in July issued conflicting rulings on health-law subsidies, raising questions about the fate of tax credits provided to millions of Americans (Armour, 9/30).Politico: Judge Rules Against White House On Affordable Care ActJudge Ronald A. White said that the administration’s decision to allow subsidies to go through either a state-run health insurance exchange or the federal exchange is an improper and invalid reading of the Affordable Care Act and must be struck. White’s ruling marks the second judgment against the government on the subsidy question and comes as the Supreme Court could decide whether to weigh in (Haberkorn, 9/30).The Wall Street Journal’s Washington Wire: Immigrant Groups Try To Block Termination Of Health PlansImmigrant advocates are accusing the Obama administration of violating antidiscrimination provisions in the federal health-care law by moving to terminate coverage for around 115,000 people who bought coverage through HealthCare.gov who didn’t take additional steps to prove they are legal U.S. residents. Two immigrant groups filed complaints Tuesday with the Department of Health and Human Services’ Office of Civil Rights asking it to block the action, which is being carried out by other units of the department. The Office of Civil Rights is in charge of enforcing rules in the 2010 law that bar discrimination in the sale of health plans (Radnofsky, 9/30).The New York Times: Detailing Financial Links Of Doctors And Drug MakersPharmaceutical and device makers paid doctors roughly $380 million in speaking and consulting fees, with some doctors reaping over half a million dollars each, during a five-month period last year, according to an analysis of federal data released Tuesday. Other doctors made millions of dollars in royalties from products they helped develop (Thomas, Armendariz and Cohen, 9/30).Los Angeles Times: Database Shows $3.5 Billion In Industry Ties To Doctors, HospitalsThe details published Tuesday in a new government database have been sought for years by consumer advocates and lawmakers concerned that conflicts of interest in the medical profession are jeopardizing patient care and costing taxpayer-funded health programs. This first batch of payment data covers just five months of 2013, but it shows the extensive ties medical companies have forged with doctors and academic medical centers across the country. About 546,000 U.S. physicians and 1,360 teaching hospitals received some form of compensation (Terhune, Levey and Poindexter, 9/30).The Wall Street Journal: Doctors Net Billions From Drug FirmsThe database revealed some eye-popping totals, such as the $122.5 million paid by Roche Holding’s Genentech unit to City of Hope medical center in Duarte, Calif., as royalties on sales of several products including blockbuster cancer treatments Herceptin and Avastin. Genentech licensed patents from City of Hope based on research the medical center conducted in the early 1980s. The company said that excluding the City of Hope royalties, about 85% of the physician payments it reported to CMS were focused on drug research. City of Hope said the royalties are allocated to the inventors and to support continuing research (Loftus, 9/30).The Washington Post’s Wonkblog: You Can Now Track The Billions That Drug Companies Pay Doctors And HospitalsThanks to a bipartisan transparency initiative contained in the 2010 Affordable Care Act, the federal government has compiled a massive database of how much drug and device companies spend on consulting fees, research grants, travel, free lunches and other items worth more than $10. … The rollout of this federal database has been somewhat problematic. Records aren’t complete — about 40 percent of payments have been de-identified because of problems with the data. The Centers for Medicare and Medicaid Services, the agency publishing the database, is holding back other records that are still in dispute. It’s also been difficult to navigate the database this afternoon. But these payments will be published on a regular basis, and the quality and reliability of the information is expected to improve (Millman, 9/30).The Associated Press: Drug And Device Firms Paid $3.5B To Care ProvidersThe massive trove of information named companies and many of the recipients. Also listed were types of payments, with details down to travel destinations. Some 546,000 clinicians and 1,360 teaching hospitals received benefits. It’s part of a new initiative called Open Payments, required by President Barack Obama’s health care law. It was intended to allow patients to easily look up their own doctors online, but that functionality isn’t fully developed. In future years, the information will cover a full 12 months and will be easier to search, officials said (9/30).NPR: Database Flaws Cloud Sunshine On Industry Payments To DoctorsBut the database is also something else: a very limited window into the billions in industry spending. Before you dive in and search your doctor, here are five caveats to keep in mind (Ornstein, 9/30).Politico: ‘Data Dump’ Reveals Billions In Pharma Payments To Docs, HospitalsIn its first hours, the website was tortuously slow. And it was incomplete: About 40 percent of the records do not identify the recipient because CMS could not match data provided by manufacturers with existing databases (Wheaton, 10/1).The Wall Street Journal’s Pharmalot: Does The Open Payments Database ‘Distort’ What Docs Get For Research?The database, which is being administered by the Centers for Medicare & Medicaid Services, will initially display payments made in the last five months of 2013 and will be updated going forward. Already, though, both industry and physician groups have complained that payment data lack sufficient context for the public to understand what doctors are paid. And doctors also griped they had little time to review data. Now, a group of academics from Johns Hopkins University have raised another issue. The law requires drug makers to report the total amount of “research payments” to researchers for use in clinical trials. But the academics – three bioethicists and a professor of medicine and pharmacology – argue this stipulation creates a “distorted” image of the money that doctors may receive, because it does not break out a value assigned to medicines that companies provide for the research (Silverman, 9/30).The New York Times: Loss Of A Democratic Power Leaves Arkansas In DoubtMr. Beebe’s knack for knowing what his political opponent needed to get a deal done during his long tenure in the legislature has served him well in the governor’s office. He has been able to get past the kind of partisan impasses that plague Washington. No one tries to lump Mr. Beebe with Mr. Obama, but the same cannot be said for Senator Pryor, whom Mr. Cotton called “a loyal foot soldier for Barack Obama and his agenda.” And yet Mr. Beebe worked with Republican legislators to put together, and pass with the required three-fourths majority, a private-option health insurance program that has helped more than 200,000 poor residents get covered, without the stigma of being associated with the unpopular Affordable Care Act. The program allowed the state to take federal money to expand Medicaid under the Affordable Care Act and use that money to buy private insurance for the poor, instead of adding them directly to the Medicaid rolls. Also, it brought the state national attention for its bipartisan collaboration (Chozick, 9/30).The New York Times: Doctors Find Barriers To Sharing Digital Medical RecordsRegardless of who is at fault, doctors and hospital executives across the country say they are distressed that the expensive electronic health record systems they installed in the hopes of reducing costs and improving the coordination of patient care — a major goal of the Affordable Care Act — simply do not share information with competing systems (Creswell, 9/30).The Wall Street Journal: Walgreen Profit Remains Pressured By Drug Price MiscalculationWalgreen Co. continues to pay the price for a miscalculation in the pricing of generic prescription drugs. The pharmacy chain shocked investors in August when it slashed its long-term profit forecast because it had failed to account for a rapid rise in the price of generics as it negotiated contracts to provide prescription drugs under Medicare’s Part D program. On Tuesday, it warned that lower drug reimbursement rates and higher costs for generic drugs will continue to hurt profits (Ziobro and Calia, 9/30).The New York Times: Freelancers Union To End Its Health Insurance Plans In New YorkThe Freelancers Union, which provides health insurance to 25,000 of its members in New York State, is ending an experiment in providing low-cost insurance to independent workers, saying the new landscape created by the federal Affordable Care Act makes it impossible to do so (Hartocollis, 9/30).The Washington Post: ‘Death Doctor’ Who Profited From Unnecessary Chemotherapy For Fake Cancers Could Resume Practice In 5 YearsThe Michigan state house health policy committee approved the proposal to tighten the rules. Next it will go before the full house for a vote. Fata pleaded guilty in U.S. District Court earlier this month to 13 counts of health-care fraud, one count of conspiracy to pay or receive kickbacks and two counts of money laundering. He will be sentenced in February and faces up to 175 years in prison (Sullivan, 10/1).Check out all of Kaiser Health News’ e-mail options including First Edition and Breaking News alerts on our Subscriptions page. First Edition: October 1, 2014 This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.