MedPAC Presents Policy Options For Reporting Physicians’ Ties To Industry
Full article reprinted from "The Gray Sheet" - September 8, 2008
Find out how the legislation pending on public reporting of physicians' ties to industry, a group of independent advisors to Congress presented an early blueprint for a federal reporting system that could inform the final version of the bill.
Full article reprinted from "The Gray Sheet" - September 8, 2008
With legislation pending on public reporting of physicians' ties to industry, a group of independent advisors to Congress presented an early blueprint for a federal reporting system that could inform the final version of the bill.
The recently revised Physician Payments Sunshine Act, first introduced in the Senate by Chuck Grassley, R-Iowa, and Herb Kohl, D-Wisc., last fall, calls for a publicly available database containing physicians' names, payments made to them by companies and the purpose of those payments (1"The Gray Sheet" June 23, 2008, p. 15).
The delay in getting the Sunshine bill passed gives the Medicare Payment Advisory Commission a chance to provide further input on the proposed federal database with specific policy options and some words of warning about mandating a nationwide reporting system.
MedPAC first supported increasing transparency of physician-industry ties and potential conflicts of interest in its June 2008 biannual report to Congress.
At a Sept. 4 meeting in Washington, D.C., the group presented a preliminary framework for the reporting system. MedPAC's overview raised as many questions as answers, which will be taken up at the next meeting. The commission then plans to draft recommendations to present to Congress at a later date.
MedPAC suggested a more comprehensive reporting system than the one proposed in the Sunshine bill. The committee recommended requiring device, drug and supply companies of all sizes to report payments greater than $25 to physicians, academic medical centers, continuing medical education (CME) organizations and patient and physician advocacy groups.
The Sunshine act only requires reporting of payments to physicians or the entity employing them.
Industry should report everything from gifts, meals and entertainment to honoraria, consulting and speakers' fees, education, research, investments and product royalties, MedPAC staff suggest.
The commissioners embraced full disclosure, but disagreed on whether reporting requirements should cover payments made to entities other than physicians.
"If the goal is to ensure that physicians aren't being unduly influenced, knowing what goes to CME isn't going to do it for you," said MedPAC commissioner Nancy Kane, Harvard School of Public Health. "I wouldn't broaden the reporting requirements to every intermediate organization that gets the money because you can't link it back down to the individual doctor."
The commissioners also reevaluated whether the $25 threshold, also proposed in the Sunshine bill, was too low to provide useful information on financial relationships.
"I worry a little bit about having a threshold that is too low and that we get too much information and the important information is lost," health policy consultant William J. Scanlon said.
"We demean lots of professions to think they're going to be influenced by a hamburger and a free pen," added Robert D. Reischauer of D.C.-based social policy research group The Urban Institute.
The public database should be Internet-accessible, clearly define the category of each payment and should allow users to search for payments by type, amount, physician and manufacturer, MedPAC proposed.
"It's not all about 'Gotcha,'" said Mitra Behroozi of welfare trust fund 1199SEIU Benefit and Pension Funds. "It's not all about pointing out the bad people doing the bad things, or even some people in the middle who do not realize they're doing bad things. One of the purposes is just for researchers to examine the impact of payments. Maybe it's something that explains a lot of this geographic variation that we're looking at."
Closing The Trade Secret Loophole?
Industry fears public reporting of physician interactions will jeopardize trade secrets, such as consulting or research arrangements.
"Transparency can be a good thing, but even good things can have unintended consequences," said Commission Chairman Glenn Hackbarth. The key will be "carefully weighing the risks and benefits."
MedPAC proposed delaying the disclosure of payments related to a new product either until a clinical trial is registered on NIH's Clinicaltrials.gov web site, or until FDA approves the product, but no later than a set amount of time after payment is made, such as two years.
Reischauer remains wary of letting firms "withhold information that's deemed by them to be proprietary. That strikes me as a loophole that you could drive an aircraft carrier through."
"Better to be non-specific about what the purpose of the grant was than to not disclose it for a few years," he said.
MedPAC did not reach a final decision on whether the federal reporting law should override similar financial disclosure laws implemented at the state level. Five states and the District of Columbia have such programs, but legislation recently introduced in Massachusetts is the only state bill that addresses devices specifically (2"The Gray Sheet" Aug. 18, 2008, p. 3).
MedPAC says preemption might reduce the compliance costs for manufacturers, but Commissioner Scanlon observed that it may overreach the federal government's authority.
One alternative would be allowing states to collect information that is not already collected under the federal law, MedPAC suggested.
Conflicts Of Interest In Physician-Owned Hospitals
MedPAC is also considering ways to gather more information about the growing number of physician-owned specialty hospitals and Medicare-supported ambulatory surgical centers. Physician-owned specialty hospitals more than tripled from 2002 to 2008.
Payers and researchers say it is difficult to obtain information on financial relationships in these facilities, and some research suggests these arrangements between hospitals and physicians increase the volume of certain procedures without improving patient care (3"The Gray Sheet" March 12, 2007, p. 9).
Hospitals and ASCs enrolled in Medicare already report individuals who own 5% or more of the facility, but the data is not publicly available. Congress could require all hospitals and ASCs to report all physician owners to CMS for public posting, MedPAC suggested.
- Jessica Bylander
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