COVID-19 Update: Read our messages to employees and clients

October 14, 2014
The Physician Sunshine Act: The Good, the Bad, and the Upside

The first round of data logged by the Physician Payments Sunshine Act is now coming to light. The act requires manufacturers of drugs, medical devices and biological, and group purchasing organizations (GPOs) that participate in U.S. federal healthcare programs to report payments, transfers, ownership and items of value given to physicians and teaching hospitals. The Centers for Medicare & Medicaid Services (CMS) calls this reporting system the Open Payments Program, and reports on 2013 data were made public beginning September 30.

So what does it mean for patients and physicians? Here’s a quick summary.

The good — Patients want transparency from their physicians, whether it’s down to disclosures about their personal medical histories or physicians’ relevant financial interests. According to a recent study, “Most (patient) agreed that disclosure of competing interests by doctors is important (84%), believing this disclosure would help patients make better informed treatment decisions (78%). Eighty per cent of patients stated that they would have more confidence in their doctor’s decisions if interests were fully disclosed, with strong support for verbal disclosure during the consultation (78%).” A clear majority of patients want to feel in the know, and reporting via the Open Payments Program is a step toward building trust in physicians and their medical decisions.

The bad — Although manufacturers will be the ones turning information over to CMS, the Physician Sunshine Act will result in yet more administrative side-tasks for physicians. To protect against errors that may damage their reputations, physicians will have to check with manufacturers and GPOs they’re associated with, in order to understand what those companies are tracking and will be reporting. Physicians are also able to check the CMS website, where the consolidated reports are posted, to look for errors.

Once CMS provides access to individual consolidated industry reports, physicians will be able to challenge the information by contacting the company through the portal. If the parties can’t resolve the dispute, the information will be flagged but will remain on the public website. Physicians can sign up with the CMS portal to receive notice when reports are made available to physicians, before public posting. In addition, the American Medical Association has developed a toolkit to help ease the burden for physicians.

The upside — If a physician holds any ownership interests in a manufacturer or GPO, or receives payments, transfers or items of value from these types of companies, the information will become public. Patients will now be able to find out the nature of payments or values of transfers for a range of payment categories, including consulting fees, grants, honoraria and charitable contributions. However, there are many things that won’t be reported, such as securities ownership in private companies, discounts, and product samples. It’s not “full” transparency, but it’s a solid start.

CMS acknowledges that “financial ties alone do not signify an inappropriate relationship,” but having such data out in the open will help reveal the nature and extent of relationships; prevent inappropriate influence on research, education, and clinical decision-making; avoid conflicts of interest that can compromise clinical integrity and patient care; and minimize the risk of increased health care costs.

The bottom line is that increased transparency and scrutiny of physician financial interests is here to stay. And, as a result, a push for better communication on the part of physicians, and greater trust and improved participation from patients. Surely, we can all agree that the healthcare system can benefit from working toward these goals.

Care Navigators
As healthcare business models evolve, so should care teams.

Patients who are paired with Care Navigators report feeling less anxiety, and an increased ability to self-manage their conditions between visits. And providers report increased job satisfaction from improved efficiency, and knowing their patients have access to care teams, and strategic support.

Chronic Care Management
With an increased aging population managing two or more chronic illnesses, extending your care teams’ ability to communicate with patients is critical. We take a strategic approach to helping patients chart a path towards their health goals, while self-managing their chronic conditions between clinical visits.

Artificial Intelligence
Our advanced AI solutions tackle complex documentation challenges to reduce the administrative burden preventing doctors from delivering precision care. We'll guide you through the best practices for incorporating AI into your workflow. Gain visibility into your data with enhanced analytics driven by AI and CTAs.

Nurse Care Team Assistants
Adding a qualified Nurse CTA to the care team increases quality of work-life and reduces stress on nurses. The nursing profession is also experiencing an alarming shortage due to increased clerical burdens and burnout.

Scribe Services
There’s a reason why we’re the nation’s most frequently used scribe company: we offer professionally trained in-person and virtual medical scribes to meet the specific needs of our clients. We offer a variety of scribe programs, as well as technology and personnel solutions that address revenue cycle management, the transition to value-based care, and more through our HealthChannels family of companies.