Heath Care Law Update: The law defines “payment” to include almost any imaginable transfer of value...
February 21, 2014
The Physician Payment Sunshine Act is a minor part of the Affordable Care Act, but it could result in major headaches for physicians. The chief purpose of the Sunshine Act is to make any payments made by medical manufacturers to physicians publicly available.
Before you think you are off the hook because you don’t receive cash compensation from your favorite pharmaceutical manufacturer, the law defines “payment” to include almost any imaginable transfer of value, whether it is the free meal at your office, journal reprints or even a charitable donation in your name. In addition to payments made to physicians, the Sunshine Act will make public any investment interests physicians have in medical manufacturers.
Even though the responsibility for collecting and reporting this information rests solely on the manufacturers, taking the following five steps can help you ensure that when information about you is made public, it will not be filled with errors.
(1) Take the time to understand what is and is not publicly reportable. For example, if you know that the anatomical model you are given to help explain a procedure will not be publicly reported, you don’t have to go through the hassle of tracking it. On the other hand, if those once a month meals from a manufacturer total $108 of value for the year, they will have to be reported -- even though each meal by itself is under the $10 limit for reporting. The ins and outs of what must be reported can get pretty complicated, so it is better to know this on the front end than to be surprised when you are in a news report about having close ties with the pharmaceutical industry.
(2) Keep track of any payments or investments as you go. Before information about you is made publicly available, you will have an opportunity to dispute any inaccuracies. However, if you haven’t kept track of payments and other transfers of value throughout the year, it will be difficult to check and even harder to dispute if you find an error. Track payments and investments on your own with a spreadsheet, or try out a new (and free) smartphone app called “Open Payments Mobile for Physicians.” You can also ask manufacturers to send advance reports so you can review them before they are reported to CMS.
(3) Document any refusals of payment in writing. Remember “payments” can include just about anything. If you don’t eat the weekly meal from the manufacturer delivered to your break room, but the manufacturer is not aware that you are refusing the “payment,” it will be reported. And, it will be hard to prove you didn’t eat once the “evidence” is gone!
(4) Update your current disclosures. Now that anyone will be able to see all of your relationships with manufacturers, don’t get caught looking like you are trying to hide certain relationships when making disclosures for CME or other business purposes.
(5) Sign up with CMS in early 2014. Since you only have 60 days to dispute any inaccuracies before reports are made public, go ahead and register with CMS as soon as possible so that they will notify you immediately once your information becomes available to review. If you are not able to resolve a dispute with a manufacturer before the 60 days is up, the information will still be publicly reported, but flagged as a disputed claim.
Scott Hultstrand works with physicians, hospitals, and other health care providers to ensure compliance with the increasingly complex state and federal regulations. Prior to joining Nexsen Pruet, he was general counsel and vice president of external affairs for the South Carolina Medical Association.