Medicare Payment Advisory commissioners voted to recommend to Congress that drug and medical device makers as well as hospitals be required to publicly report details about their financial relationships with doctors and other health care providers and groups. (see presentation)
The commissioners approved on Nov. 6 five such disclosure and reporting recommendations to Congress that are intended to discourage inappropriate deals among health care institutions, companies, and practitioners.
The publicly reported information also could be used by “researchers” to study how financial ties among health care providers affect practice patterns, the commission said.
The recommendations are expected to appear in a future MedPAC report to Congress this coming March. MedPAC Chairman Glenn M. Hackbarth said the recommendations were aimed at transparency, not condemnation, of financial arrangements in the health care industry.
Some of the details:
Recommendation 1
Congress should require all manufacturers and distributors of drugs, biologicals, medical devices, and medical supplies, and their subsidiaries, to report to the Secretary their financial relationships with:
Physicians
Physician groups, and other prescriber
Pharmacies and pharmacists
Health plans, pharmacy benefit managers, and their employees
Hospitals and medical schools
Organizations that sponsor continuing medical education
Patient organizations
Professional organizations.
Manufacturers would have to report payments if the total annual value of payments to a recipient exceeds $100, and this threshold would be adjusted annually for inflation. Once this threshold is reached, all payments transfers of value to a recipient, regardless of the amount would have to be disclosed.
Excluding reporting of discounts and rebates
Companies should report the value, type, and date of each payment; the name, specialty, Medicare billing number if applicable, and address of each recipient; and if the payment is related to the marketing , education, or research of a specific drug or device, the name of that drug or device.
Companies would be allowed to delay reporting of payments related to clinical trials until the trial is registered on the NIH website. Companies would be permitted to delay reporting of other payments related to development of a new product until the product is approved or cleared by the FDA, but no later than two years after the payment is made.
This recommendations ads a host of new people to the current sunshine proposals and is designed to give managed care companies and hospitals access to as much information as possible on the practices of manufacturers.
Recommendation 2
The Congress should direct the Secretary to post the information submitted by manufacturers on a public website in a format that is searchable by manufacturer; recipient's name, location, and specialty, if applicable; type of payment; related drug or device; and year.
One interesting note the MedPac staff member made about recommendation two is that Hospitals, academic medical centers, and health plans should benefit from access to information submitted by manufacturers, and physicians who receive large payments from manufacturers may receive public scrutiny.
Recommendation 3
Congress should require manufacturers and distributors of drugs to report to the Secretary the following information about drug samples:
· Each recipient's name and business address;
· if the recipient is a physician practice,
o The names,
o Specialties, and
o Medicare billing numbers of each physician in the practice;
· The name, dosage, and number of units of each sample; and
· The date of distribution.
The Secretary should make this information available to researchers through data use agreements.
According to the MedPac staff member the addition of samples will enable managed care organizations to link data on the samples to claims data on prescriptions could facilitate research on the impact of samples on prescribing behavior and drug spending.
The chairman of MedPac commented that: if you're looking for counter-detailing, a PBM or a PDP would know who the paid scripts were for, and they could look backwards and see where the samples went and generated the paid scripts and know that that's the time to do the counter-detailing. So it would be kind of a retrospective look at these things, and it would be useful.
Recommendation 4
The Congress should require all hospitals and other entities that bill Medicare for services to annually report the ownership shares of each physician who directly or indirectly owns an interest in the entity, excluding publicly traded corporations. The Secretary should post this information on a searchable public website.
HHS currently collects this information but is not available to the public, this recommendation would make it available to managed care, attorneys and others who would use this information for “research” purposes.
This is a strong agenda item for managed care to drive down the price of procedures.
Recommendation 5
The Congress should require the Secretary to submit a report based on the disclosure of financial relationships report of all the types and prevalence of financial relationships between hospitals and physicians.
This means salaries, bonuses, discounts….. you get the drift, they want to know what relationships hospitals and physicians have. This is round one of this recommendation as HHS is now starting a pilot project to collect this information, but they want access to the data to determine if they should in the future recommend full disclosure.
Couple of things came out at the MedPac meeting that crystallized what is really going on here:
A) MedPac’s members by and large represent the “payor” side of the medical equation, a majority represent, managed care companies, vendors and their affiliates are represented in this group, see bios.
There is limited representation from “payee” side of the equation including clinical development, or academic research, physician practices or community/no-academic hospitals in this panel.
B) Because of this over representation the recommendations are clearly designed to benefit “payors” in their negotiating positions and influence over prescriptions and payments to physicians and hospitals.
C) The end goal is control and to eventually to force physicians to become employees vs. independent businesses (group price negotiation).
D) The access to this information by public and “researchers” will have far reaching effects in discouraging physicians to accept samples, work on clinical research programs, educate other physicians, and have ownership in clinics, surgery centers and labs.
E) This information will lead to reductions in income to physicians and other prescribers
F) Plaintiff attorneys will have a field day with all this information including greatly enhance their gene pool of suitable targets with access to provider payments, and ownership information.
Key Documents:
MedPac November Meeting Transcript (Transparency Only) (this is a big file, so you may want to go to Starbucks while you are waiting)
MedPac November Meeting Presentation