From the Editor: Let the ‘Sunset Act?’

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The Physician Payment Sunshine Act is now in place, and I’m concerned that it may become the “Sunset Act” since it may be another reason for doctors to consider leaving the profession. As of August, manufacturers of drugs, devices, biologicals, or medical supplies are obliged to report annually to the Secretary of Health and Human Services certain payments or other transfers of value to physicians and teaching hospitals. According to the Centers for Medicare and Medicaid Services (CMS) this bit of regulatory burden is going to cost industry $269 million the first year and $180 million annually thereafter.

Dr. Russell Samson

What is the purpose of this “Sunshine Act”? Congress implied that this process is not designed to stop, chill, or call into question beneficial interactions between physicians and industry, but to ensure that they are transparent. Although CMS did not use harsh or derogatory language, what I think is “transparent” is the implication that making these financial interactions public will prevent industry from having undue influence over physicians. In less euphemistic terms I believe CMS thinks it will prevent physicians from taking industry bribes.

James Barrie once said, “Those that bring sunshine into the lives of others cannot keep it from themselves” – yet I note that our politicians have not passed similar legislation for themselves.

So what does this Sunshine Act mean for vascular surgeons? In short, any amount of money paid directly or in kind (such as a free meal) in an amount exceeding $10, or if less than $10 amounting to more than $100 over a year, has to be reported by these companies to a national database. This will be made public for all our patients to see. I think it’s actually quite comical that CMS set the level of $10 for reporting. They clearly think this amount is enough to influence us. That’s probably because they realize that Medicare has reduced our income so dramatically that we would be willing to sell our mothers for $10!

Now, like every other law enacted by the government, it took CMS 287 pages to describe how to interpret this supposedly simple law. Despite the length, I would urge everyone to read the final rule – but a good dose of Maalox should help. For in this extensive document CMS outlines rules such as how companies will determine how to report food a physician consumes at a national convention.

The final rule determines how research monies should be accounted for and describes regulations for reporting payment for talks given to groups of referring physicians. I was especially intrigued by the convoluted mathematics that CMS invented to determine the dollar amount a company needs to report for the food provided by their representative for lunch for physicians and their staff. It goes something like this: If the food cost $180 and two of the four partners and three staff eat the food, then the per person food cost would be $36. That then becomes the amount that would be reported for each of the two doctors who got diarrhea from the bad food!

Now, just to prove that CMS is not manned by a group of old fogies, they have even created an app for our smartphones so that we can track what is being reported. But we are obliged to enter the data ourselves, and we can’t use this as proof that an incorrect report was made. So, while physicians will have a minimum of 45 days to challenge information before it is public, and can dispute inaccurate reports and seek corrections during a 2-year period, it is advisable to review and correct all information before it is published. To not do this would be the same as asking the government to do our taxes rather than having our accountant do them!

It is certainly true that abuses have occurred where unreasonable amounts of money have been paid to doctors to promote the use of drugs and medical products, and where research may have been tainted by profit motives. Furthermore, travel junkets thinly disguised as educational meetings have caused many to look askance at the relationship between industry and physicians. Improprieties have occurred by physicians on hospital purchasing committees because of undue influence from industry. And yes, some doctors would sell their mothers for 10 bucks. But, on the whole, we remain one of the most honest of professions. So was it really necessary to add another impediment to the doctor-patient relationship?

When our patients eventually look at this database, will they really be able to differentiate between monies for research or those used to provide lunch to an office? Will they regard physicians as crooks just because they were reimbursed for lecturing at a scientific meeting? Maybe! Actually, I suspect my patients won’t bother to look at the database but those that do will just be confused. Regardless, I suspect we will now be spending time explaining ourselves rather than explaining treatments. So much for Sunshine!

Dr. Russell Samson is the Medical Editor of Vascular Specialist.

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