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Reform Update: Aug. 1 brings deadline to report physician payments


By Andis Robeznieks
Posted: July 29, 2013 - 4:00 pm ET
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While much attention was given to the decision to delay the Patient Protection and Affordable Care Act's employer mandate by one year, another ACA deadline quietly arrives this week.

As of Aug. 1, group purchasing organizations and drug and medical-device manufacturers will have to report any “transfers of value” of $10 or more they make to doctors and teaching hospitals. The new requirement is contained in Section 6002 of the ACA and was known as the Physician Payments Sunshine Act, but was rebranded by the CMS as the “Open Payment Program.” Drug samples for patient use or coupons to receive a sample will not need to be reported.

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The burden of collecting and reporting data will be on the industry side, but physicians are encouraged to keep their own records and they will have 45 days to review disclosures and seek corrections if they dispute what is being reported about them. The CMS is encouraging doctors and companies to settle disputes by themselves and said it would not mediate disagreements but will note if a figure is being disputed.

“Dispute rate will be something that matters to us,” Dr. Shantanu Agrawal, director of the CMS Data Sharing and Partnership Group, said at last month's meeting of the American Medical Association House of Delegates. “This could become a trigger for an audit.”

Along with payments, manufacturers and GPOs are required to report ownership interests in their company by physicians and by physicians' immediate family members.

The CMS is holding a national provider call on Aug. 8, one week into the program. Doctors of medicine, osteopathy, chiropractic medicine, dentistry, dental surgery, optometry and podiatry are encouraged to participate and have their questions answered.

The AMA also has a section of its website devoted to the Sunshine Act, and it gives advice on what to say to patients who are curious about their doctor's industry relationship.

“When a patient asks about this topic, it is important that you discuss the matter candidly in a way that will enhance the patient's understanding without compromising trust or the patient-physician relationship,” the AMA recommended. “Some of the issues you might want to address with the patient are what sources you rely on for information about medical innovations and new evidence, your role in medical research, and how you believe research will improve outcomes for patients.”

The American Academy of Orthopaedic Surgeons has a similar statement on its website.

“Orthopaedic surgeons who have relationships with medical device or pharmaceutical companies should carefully study the Sunshine Act's implementing regulations to understand their impact on day-to-day activities as well as on perceptions of patients, the media, enforcement authorities and the public,” the AAOS advised its members.

The Sunshine Act was originally sponsored by Sen. Chuck Grassley (R-Iowa) and former Sen. Herb Kohl (D-Wis.).

“The goal is to help inform consumers and patients in all medical fields about financial relationships between drugmakers and doctors, with uniform disclosure,” Grassley said back in April. “The public deserves a much better picture of the drug industry's financial presence in medicine than it has today.”

“We strongly urge physicians to make sure all of their financial and conflict of interest disclosures, as well as their information in the national provider identifier database, are current and regularly updated,” Dr. Ardis Dee Hoven, AMA president, said in a news release. “We also urge physicians to ask industry representatives with whom they interact to provide an opportunity to review and, if necessary, correct all information they will report before it is submitted to the government.”

Study suggests systems adopt injury prevention programs for children, young adults

Injury-prevention programs would be one good way for healthcare systems to cope with the influx of newly covered patients under the Patient Protection and Affordable Care Act, according to a study in the journal Clinical Pediatrics.

Using data from the National Health Interview Survey, researchers from Children's Hospital of Philadelphia and other institutions identified almost 12 million injuries to individuals 26 years old or younger that received medical attention in 2008. The researchers projected that this number could increase by 730,000 (6.1%) because of new rules that will allow adults up to 26 years old to remain on their parents' health plan and because subsidized health plans will be available to young adults through health insurance exchanges. Most of these patients would be seen in outpatient settings.

“Healthcare delivery systems across the U.S. need to have sufficient numbers of general and pediatric healthcare providers who are trained in treating moderate trauma and injury and can staff urgent-care centers, health centers, primary-care practices, call centers and emergency departments,” the study's lead author Dr. Flaura Koplin Winston, scientific director of Children's Hospital of Philadelphia's Center for Injury Research and Prevention, said in a news release.

“Injury is the leading health risk for children and young adults,” Winston added. “Proven prevention strategies and appropriate acute care will reduce fatalities and the long-term consequences that injury can have on quality of life.”

Playing the numbers game with Medicare docs

As evidenced by the U.S. Supreme Court decision upholding the law, the language of the Patient Protection and Affordable Care Act is open to interpretation. Now a recent article in the Wall Street Journal illustrates how numbers can be interpreted differently as well.

“More doctors steer clear of Medicare” trumpets the headline of a Wall Street Journal article telling how the number of physicians opting out of Medicare in the last three years has “nearly tripled.” While the total number of these physicians has nearly tripled, they still equal less than 1.4% of the number who are opting in.

Citing figures from the CMS, the article reports that 9,539 doctors opted out of Medicare in 2012 compared to only 3,700 in 2009. The article then makes a quick mention of how 685,000 doctors did participate in Medicare last year before devoting paragraph after paragraph to the “small but growing number” of physicians dropping out of Medicare.

The WSJ article also cites a Health Affairs study which found that 33% of primary-care physicians didn't accept new Medicaid patients in 2010-11. The title of that study, by the way, is “Two-thirds of primary care physicians accepted new Medicaid patients in 2011-2012: A baseline to measure future acceptance rates.”

Follow Andis Robeznieks on Twitter: @MHARobeznieks


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