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Physician Payments Sunshine Act Goes Into Effect Without Initial Concerns

By Kelsey Miller

August 5th, 2013, 5:45 AM

The Physician Payments Sunshine Act, an Affordable Care Act provision requiring doctors and medical companies to disclose their financial relationships, went into effect Aug. 1. Physicians say they are now working to find a balance between necessary transparency and what some perceive to be burdensome filing.

“We want to spend our time seeing patients, not doing paperwork,” said Dr. Jason Mitchell the director of the Center for Health IT at the American Academy for Family Physicians.

The Sunshine Act requires drug companies and medical device makers to report payments, gifts and investments to Centers for Medicare and Medicaid Services. Though the act is now in effect, a complete set of records are not due until March 2014 and will not be made public until September 2014.

Consumer advocates and other stakeholders favor openness when it comes to the large amounts of money medical and pharmaceutical companies spend to influence a doctor’s choices, according to a Pew Health Center statement from 2012. Holding both parties accountable with a clear reporting system would allow consumers to spot potential bias.

Mitchell, who is also a practicing family physician in Missouri, does not anticipate many immediate changes for doctors – aside from fewer lunches with pharmaceutical representatives.

He predicts that because of the increased attention placed on these small meetings that make up a majority of the reportable interactions, doctors will likely shy away from them – which could be problematic. If doctors minimize their working relationships with pharmaceutical and medical representatives, their knowledge could be “less of a resource,” Mitchell said. It’s important for doctors to keep up with drug and product information in other ways, he added.

In an effort to simplify the reporting of these payments, a number of iPad and iPhone Apps have been developed. Doctors and industry professionals can enter data by hand or scan documents which are filed into easy lists and spreadsheets.

The Centers for Medicare and Medicaid Services created different Apps designed specifically for doctors and others for medical companies, both of which have to remain accountable for these transactions.

Though it’s up to the companies to do the reporting, doctors are encouraged to keep their information up to date and to follow up on what transactions are being reported.

“There’s no reason to believe it will be erroneously reported,” Mitchell said. “We don’t have anything to hide. We certainly are very conscious of conflicts of interest.”

“Transparency is a good thing,” Mitchell said. “But we certainly don’t want an increased burden.”

13 Responses to “Physician Payments Sunshine Act Goes Into Effect Without Initial Concerns”

  1. Mike says:

    Physicians? Transparency? Isn’t that a classic definition of an oxymoron? Don’t have anything to hide? How about those drug company reps that are constantly sitting in your waiting room?

  2. George says:

    As part of physicians wanting to make sure the right data is attributed to them, pharma can now send data to HCPs prior to sending it to CMS through ePharmaRep. Physicians can also help validate the data collection and processing being done by manufacturers by receiving this data on an ongoing basis, thereby validating it along the way, without waiting till the last minute. Check out http://www.cornerstonehealthtech.com .

  3. Debra Aronson says:

    Assuming that the disclosure of relationships is to allow the patient/consumer to consider the possibility that the medical advice dispensed might be influenced by the provider’s financial relationship with a pharmaceutical/device laboratory/imaging company, why not make the disclosure directly to the patient/consumer. ? i.e. a posted notice in the physician office that the provider is a member of the partnership that owns the imaging center? or, here is a list of those pharma companies that have paid me more than XXXX in the past 12 months?

  4. Miles says:

    QUESTION: If I’m getting positive results on a brand named drug and that drug goes generic, why is it my doctor always seems to find another brand named drug to prescribe for the same condition?

    You’ve heard of the merry-go-round. I see it as a money-go-round where only doctors and big pharma get to ride. The consumer never gets to ride because the ride is always closed for them. With any luck, maybe the ACA will change that.

    On 1/1/2014, the health exchanges will provide the much needed level the playing field for private insurers to compete. The rules will apply to “all” private insurers in the exchange. Private insurers must all offer the exact same products spread over four different comprehensive choices. Bronze, Silver, Gold and Platinum. The only thing left for consumers to do it find their choice at the best price. Any private insurers that try to cheat, like some did in the past, will find that they will not have customers buying their products. The exchange will weed out the bad actors. Sounds like good old-fashioned competition to me!

    So, maybe we will also see new rules that better enforce transparency between big pharma and providers. Not holding my breath.

  5. James says:

    The way you describe the health exchanges is very interesting. Almost like a municipal stadium (health exchange) where private teams (private health insurers) come to compete. Many large cities build sports stadiums and offer them to private sports teams to make a profit. These private teams (private insurers) pay a fee for the use of the stadium (health exchanges) but the fee is nothing compared to the profit that the teams (private insurers) will make. Once the teams (private insurers) meet in the stadium (health exchange), they must compete by the exact same rules. No team (private insurer) gets a special advantage. Each team (private insurer) competes and the fans (customers) decide which teams (private insurers) are popular and which are not. Those teams (private insurers) that cheat in any way are penalized and sometimes are not invited back. The teams (private insurers) that play fairly and offer a good performance are the teams (private insurers) that profit. The bad teams (corrupt private insurers) are never seen again. That’s a great way to explain the health exchanges!

  6. Larry says:

    To the folks that believe Obamacare and the health exchanges will be a massive government takeover of healthcare. Fact is, like someone else said, the health exchanges will be like a public municipal stadiums where private sports teams come to compete. Many large cities build public sports stadiums and offer them to private sports teams for those teams to make a profit. Take for instance, the City of Brotherly Love. The City of Philadelphia owns all of the sports stadiums on Broad Street in South Philly! These stadiums are public stadiums. The City of Philadelphia charges a fee for private teams to come and use these stadiums. You can equate these private teams to private health insurers. You can equate the public stadiums to the public health exchange. It’s just another way to explain the truth about the health exchanges! Like someone said, it’s just good old-fashioned competition! The health exchange merely provides a level playing field for private insurers to compete. Next time you get told the lie that Obamacare is a massive government takeover, I hope you share this story.

  7. Tony says:

    @miles: I have the other problem: When the drug went generic, I was forced to accept the generic – which was despite advertisement to the contrary, was not as effective. I had to fight doctor, insurance, and pharmacy to get the name-brand.

  8. Fred Matthies says:

    Dr. Mitchell, please get on board with transparency, not excuse our colleagues. Have you not read our colleague Howard Brody’s book “Hooked: &c.” and the corruption documented therein?

  9. Larry says:

    Hey Tony; Did you know than studies have shown strong evidence that generics work just as well as brand-name drugs? Why would anyone purposely choose the more expensive brand-name drug when the generic drug works just as good? Is it because some doctors try to convince their patients into believing that lie? In my opinion, there’s something fishy going on when doctors tell you brand-name drugs work better than the generic. Could it be that the doctor is taking a bribe to prescribe the more costly drug?

  10. Paul Chernoff says:

    I am confused a bit about the difficulty of reporting. Don’t doctors have to report these payments on their income taxes anyway? I understand that this is an additional reporting action but they should be tracking these payments anyway us.

  11. Chris 67 says:

    “Oh its such a drag. We’ve now got to report our own corruption!”

  12. dw says:

    If reporting is such a “burden”, the doctors could always decline to accept the payments in the first place…

  13. Pongo says:

    And, of course, these payments and inducements will be clearly spelled out on any informed consent document patients sign before participating in potentially dangerous drug trials, right? Because surely to be fully informed, you need to know whether the doctor has financial incentive to keep you in a trial even when it would be in your medical best interest not to continue? Not disclosing these facts would make it impossible for a prospective participant to be ‘fully’ informed, right?

    It is important that research participants know that they can’t be well compensated because it is considered unethical to induce them to potentially harm themselves. However, a doctor in the pay of pharma can be induced to harm others and this is perfectly legal.

    Clinical trials are critical for moving healthcare forward and this ethically tainted way of managing them is a threat to the entire endeavor. The bad players (many of them the biggest names in pharma) are making it impossible for ethical companies to compete without resorting to the same tactics. If you want to know what future trials will look like if this does’t get reigned in, Google the case of Dan Markingson at the U of MN. Maybe skip breakfast first, as this case is guaranteed to nauseate you.

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