Despite controversy, Sunshine Act backers look to expand law's reach

Requiring healthcare providers to disclose their financial relationships with healthcare manufacturing companies has been a step in the right direction for transparency, but the information has to cover more types of providers and be put in better context in order to improve the quality of care and stem spiraling healthcare costs.

That's what policy advocates, researchers and providers themselves have learned following the first round of disclosures mandated by the Physician Payment Sunshine Act (PPSA), according to experts at a forum hosted by the National Coalition on Health Care on Wednesday at the U.S. Capitol Building in the District of Columbia.

The first disclosures indicated that a total of $3.7 billion in transactions took place between physicians, hospitals and other providers and the pharmaceutical and medical device industries from August to December 2013, according to data from the Centers for Medicare & Medicaid Services (CMS). These transactions, which are available through CMS' Open Payments database, include money for research activities, gifts, speaking fees, meals or travel. The disclosures reported to the government involved 366,000 doctors as well as 1,303 healthcare manufacturing companies.

One of the panel's speakers, Rodney Whitlock, emphasized that the disclosed transactions are "perfectly legal" unless they fall under federal kickback statues. Whitlock is the health policy director for Sen. Chuck Grassley (R-Iowa), one of the two lawmakers who first introduced the bill, which was passed in 2010 amid bipartisan support.

"If these transactions remain legal, and we believe that they should be, then they should be publicly reported and be available to the public," he said, later adding "we're better off with more information than less."

Panel speaker Adriane J. Fugh-Berman, an associate professor at Georgetown University Medical Center and participant in the organization PharmedOut, which advocates against pharmaceutical marketing influence in medicine, took a more hardline approach to cozy relationships between providers and manufacturers.

"Patients shouldn't see doctors who see drug reps," she said.

Fugh-Berman detailed how pharmaceutical marketers have shifted tactics in response to the PPSA, in some cases targeting physicians' social and professional networks with their message given that many doctors now refuse to meet with marketing representatives.

Marketers have also increased their focus on non-physician healthcare players such as nurse practitioners, physician assistants, social workers and payers, all of whom aren't yet required to disclose transactions with medical manufacturers.

In looking for ways to improve the law, including such non-physician providers is high on the list, Fugh-Berman said, a sentiment echoed by other panelists. 

"There is no requirement in the PPSA to report any payments to these practitioners," she said.

Other key improvents include streamlining the user interface on CMS' website--reported by FierceHealthIT to be full of glitches at its launch--and better explaining the different categories of transactions so consumers can truly understand their doctors' disclosures, said Allan Coukell, Pew Charitable Trusts' senior director of health.

Indeed, despite Fugh-Berman's statement that "physicians don't like" the PPSA, Whitlock said doctors who have nothing to hide have nothing to fear from the law's disclosure mandates.

"A provider who wants to become more educated [about a new drug or device] is OK," he said. "Really no one should be afraid of explaining it to their patient."

But even as Americans become more educated healthcare consumers, the practice of patients asking their providers to explain their financial transactions with manufacturers isn't yet common, panel member William B. Jordan, M.D., president-elect of the National Physicians Alliance and practicing family physician, told FiercePracticeManagement in an eclusive interview. And while medical societies are profoundly aware of the law's implications, most providers themselves haven't yet felt the effects, Jordan said.

"I don't think most doctors are aware of what's going on [with the law]," he said. "It hasn't really trickled down to the rank and file yet."

Indeed, with data for 2014 collected and slated to be published by CMS in June, according to Coukell, all the panelists agreed that the PPSA's job is far from finished.

"We really need to understand in this country the drivers of healthcare costs--where those dollars go," he said. And in order to do this, "the culture change in medicine toward more transparency will have to continue."

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