The Sunshine Act is part of the Patient Protection and Affordable Care Act passed in 2010. This act went into effect in August of 2013 and requires the full disclosure of any payments (or transfers of value, i.e., lunches and dinners) made to physicians from pharmaceutical and medical device manufacturers.
The spirit of the act is to have more transparency with regards to potential conflicts of interest created when physicians receive benefits from these industries. From the patient’s perspective, they have the right to know if their physician is potentially being influenced to prescribe certain drugs or use particular devices based on gifts received. There have been some studies that have suggested that this influence is real.
Data regarding these payments are made public yearly by the Centers for Medicare and Medicaid Services (CMS). The full list of reportable payments includes:
- Travel vouchers
- Speaking fees
- Research stipends
- Stock options
Any payment less than $10 is excluded from reporting, unless the payments amount to greater than $100 each year.
Also, it turns out the national mean for reported compensation was $3,289.86 in 2016, just in case you were wondering where your compensation falls on the spectrum. Of course, this only includes those physicians with reportable gifts received. If you included all physicians, the national mean would be much, much lower.
Looking further into the details, it appears that participating in medical surveys is excluded from reporting to CMS assuming a key condition is met: the identity of the person taking the survey is unknown to the pharmaceutical or medical device company. In their legal words:
SEC. 1128G (e)(10)(A): The term ‘payment or other transfer of value’ means a transfer of anything of value. Such term does not include a transfer of anything of value that is made indirectly to a covered recipient through a third party in connection with an activity or service in the case where the applicable manufacturer is unaware of the identity of the covered recipient.
I have personally participated in many medical surveys from many different medical research companies over the last five years. Most of these payments were greater than the threshold reportable value of $10. Upon searching my name in the database, I have confirmed that these honorariums have never been reported to CMS.
The dissenting opinion
Physicians argue that they are not able to justify or plead their case to patients regarding payments showing up under their name. The argument is that these reports lack the context to allow the patients to determine whether a conflict of interest is present with regards to their specific situation. Furthermore, there is also some concern that the process of disputing erroneous claims is tedious.
I agree with these arguments, the context of the payment is vital to deciding whether a conflict of interest exists. If a primary care physicians receives speaking fees to lecture about a new diabetic medication and a patient is being treated exclusively for high blood pressure, then there is most likely not a conflict. But if the same patient finds out that his physician received compensation from a pharmaceutical company last year, he might jump to conclusions without knowing the whole story.
On the other hand, if that same physician is treating someone with diabetes, then the conflict of interest should be disclosed, not only through the CMS database, but during the physician-patient interaction as well. Again, context is key for decision making.
Despite these issues, the Sunshine Act is still in effect and doesn’t appear to be going away anytime soon. At the end of the day, it’s probably not the end of the world to have your name show up in the database. Still, some physicians want to avoid having their name on there so need to be more cognizant when accepting a lunch or a voucher from a company. If that is the case, take the lunch valued at $9.99 because the one worth $10.01 will cost you your signature of approval to be listed in the database!
“Another Second Opinion, MD” is an anesthesiologist who blogs at his self-titled site, Another $econd Opinion.
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