Who pays your doctor and how might that affect your treatment? This is a question that the Physician Sunshine Act, (Patient Protection and Affordable Care Act section 6002, Transparency and Program Integrity) seeks to help consumers answer by creating a website that will begin reporting payments that physicians receive from manufacturers of drug devices, biologicals, etc.). The Act is a reporting requirement in order to promote transparency.
The website for consumers, beginning in September of 2014 and thereafter annually in the month of June, should be accessible through both the CMS website and the HHS website and will post payments that are reported by manufacturers and Group Purchasing Organizations to doctors so that consumers can better understand how a doctor’s decision-making and choice might be influenced by who’s paying him or her.
These are not necessarily illegal payments physicians receive. Penalties provided are for failures to report and are civil, in the form of fines, lower fines for unintentional failures to report by manufacturers, higher fines for deliberate failures to inform HHS and CMS (Health and Human Services and Centers for Medicare and Medicaid Services.
This is a VERY general overview designed to direct consumers towards tools to help them better choose physicians by following the money.
There are other laws, both state and Federal designed to address fraud and kickbacks and other illegal activities. This reporting is not making the assumption that payments are illegal but that the payments could influence a doctor’s prescription for patients and therefore should be available to patients.
(Section 1128 G notes that reporting requirements “…does not exempt applicable manufacturers, applicable GPOs, covered recipients, physician owners or investors, immediate family members, other entities, and other persons from any potential liability associated with payments or other transfers of value, ownership, or investment interests (for example potential liability under the Federal Anti-Kickback stature or the False Claims Act).” Find text by searching for Department of Health and Human Services, Centers for Medicare and Medicaid Services, 42 CFR Parts 402 and 403, Final Rule issued Friday, February 1, 2013.
As a consumer, it makes sense to take advantage of the transparency tools by looking up who pays your doctor to better inform you about possible influences on your doctor’s advice.
The American Medical Association has advised physicians that “Your patients may wish to know whether you have or have had financial interactions with industry.” They advise, “It is important that you discuss the matter candidly…” and that “Some of the issues you may want to address with the patient are what sources you rely on for information…” You can find this by searching the AMA website under “Advocacy Topics, Sunshine Act”.
Already there are guesses that patients won’t care. For instance, in an article entitled, “Who Paid for Your Doctor’s Bagel?” Dr. Thomas P. Stossel, professor of medicine at Harvard, on January 23, 2013 on WSJ.com asserted that “Few patients have the time, interest or competence to interpret the disclosures.”
Does money influence people’s decisions? Before you fulfill the good doctor’s prediction that you’ll have not enough time, interest or competence, consider another article entitled, “Doctors Who Don’t Speak Out,” by Barry Meier, for The New York Times, February 15, 2013 (look up the article for full story), regarding problems with an artificial hip sold by Johnson and Johnson, discussing physician’s who didn’t report problems they knew about for years before the product was recalled aside from to their employer, the manufacturer. In that article one of the reasons for failure to report by physicians was noted as because of “their financial ties to a drug or device maker.”
For purposes here, these financial payments would be disclosed to consumers through the website posting doctor payments under the Physician Payments Sunshine Act beginning in September 2014.
For all those people who still believe that malpractice claims contribute to our high costs, it should be noted that the lawsuits have begun in connection with the faulty hips. So who’s at fault for these suits? Not the patients and not the lawyers. Ask yourself, "If this is what’s done with the threat of lawsuits, what would happen if we did away with lawsuits?"
