New federal law requires manufacturers to report payments to physicians

Sunday, September 01, 2013 12:25 PM

Colorado is the sunshine state

Kate Alfano, CMS contributing writer

Colorado physicians will soon need to be prepared to review financial information posted about them online by the federal government. Under the Physician Payments Sunshine Act, manufacturers of drugs, medical devices and biologicals that participate in U.S. federal health care programs must report certain payments and items of value given to physicians and teaching hospitals.

But physicians in Colorado already self-report a large amount of information under the Michael Skolnik Medical Transparency Act. Let’s take a closer look at the two programs to understand their differences.

Michael Skolnik Medical Transparency Act
The Colorado Medical Society has been a longtime supporter of Patty Skolnik and her work to enhance and improve patient safety systems. The Skolnik Act took effect on Jan. 1, 2008, and its mission is to provide Colorado consumers access to information about their physicians so they can make more informed health care decisions. All new licensees and physicians reactivating or reinstating a license must maintain an online profile available to the public through the Department of Regulatory Agencies.

The Act requires basic information to be disclosed: full name, current address and phone number, any medical license held, current board certifications and specialties, and current facility affiliations. It also requires disciplinary information to be disclosed: criminal convictions, malpractice settlements, any action to suspend or revoke a license, actions against medical staff membership, or refusal by an insurance carrier to issue medical liability insurance.

Most similar to the Sunshine Act requirements are the financial disclosures. Under the Skolnik Act, physicians must disclose existing direct business ownership interests related to the provision of health care services or products, and existing health care-related employment contracts or contracts establishing an independent contractor relationship between the physician and an entity if the annual value of the contract exceeds $5,000.

Jason Sunstrom, director of the Office of Healthcare Professions Profiling and Systems Support, which oversees compliance with the Act, said they built the profile directly off the statute. The financial disclosures are relatively general, he said, and pertain to any business whose mission relates to health care services or products, “which could be a wide variety of things.”

The Sunshine Act
Starting Aug. 1, 2013, manufacturers are required to collect and track payment, transfer and ownership information. They will then submit annual reports to the Centers for Medicare and Medicaid Services for any direct payments or transfers of value to physicians and/or teaching hospitals of $10 or more. Product samples and educational materials that directly benefit patients are excluded, among others. In addition, manufacturers and group purchasing organizations (GPOs) must report certain ownership interests held by physicians and their immediate family members.

On Jan. 1, 2014, the federal CMS is expected to launch an online portal for physicians to sign up to receive notice when their financial disclosures are available for review and correction. On March 31, 2014, manufacturers and GPOs will report the data for 2013 to CMS. Officials estimate CMS will provide physicians access to their consolidated financial disclosures for 2013 sometime between April 2014 and August 2014. Sept. 30, 2014, is the target for CMS to make the majority of this information available on a public, searchable website.

Physicians will have 45 days to review their own consolidated transparency report and make corrections before the report is made public. They have two years to challenge reports that they feel are false, inaccurate or misleading. Any item under dispute is marked as such in the public database.

Tips for compliance
Colorado physicians are already familiar with reporting under the Skolnik law and Sunstrom said that things are going well. “We haven’t initiated any fines until recently and so far no fines have been levied against physicians; they’ve been levied against other license types.”

“We get quite a few profile searches as the word gets out to consumers,” Sunstrom said. “It’s obviously good to have the correct information out there. We remind [physicians] that it’s a living, breathing document. Anytime there’s anything that could be considered to be a change to a profile question, they need to go update their profile.”

Physicians needing assistance with Skolnik Act reporting can go online to the HPPP website, www.dora.colorado.gov/professions/hppp, or contact HPPP staff John Scott or Phillip Deeds directly at 303-894-5942 for technical questions.

While physicians don’t have the responsibility of reporting under the Sunshine Act and the information won’t be made public until 2014, the AMA advises physicians to be vigilant in preparing for its effects and recommends the following.

• Ensure that all financial disclosures and conflict of interest disclosures are current and updated regularly.
• If you have a National Provider Identifier (NPI), ensure all information in the NPI enumerator database is current and regularly updated as needed.
• Ask all manufacturer and GPO representatives with whom you interact to provide you with notice and opportunity to review and correct all information they intend to report to the federal government before it is officially submitted.
• Download and use the federal CMS’ free OPEN PAYMENTS Mobile for Physicians app to control and track transfers.
• Visit the AMA Sunshine Act webpage at www.ama-assn.org/go/sunshine, frequently for updates.

The general intent of both the Skolnik Act and the Sunshine Act is to increase transparency, to engage consumers and improve health care as a whole. Physicians must be active in reviewing information published about them online and submitting updates and corrections, and those who are will feel more at ease with the new requirements.