Physician Payment Sunshine Act: White House Health Care Plan Provisions

In preparation Thursday’s White House Summit on Health Care, this morning President Obama released on www.whitehouse.gov, his “Health Care Plan” with much fanfare.

The proposal includes many of the popular insurance reforms and increases the fee paid by pharmaceutical companies by $10 Billion.

The Physician Patient Sunshine provisions are highlighted bellow:

Title VI. Transparency and Program Integrity

Enhancing Choices with Full Disclosure of Physician Financial Interests

To give patients greater choices, doctors with financial interests in imaging services, like MRI services, must inform the patients in writing that they can obtain the recommended imaging service from a person other than the referring physician, and provide a contact list.

To prevent conflicts of interests and insure full transparency and information for patients, the Act requires all drug companies, device, and medical supply manufacturers to fully disclose and report any gifts they make or financial arrangements they have with doctors, a physician practice or group.

All pharmacy benefit managers (PBM) that manage the prescription drug portion of health plans under Medicare or the Exchange must report information regarding any rebates, discounts, or price concessions they negotiate for prescription drugs.  They’ll also have to report often they use generic drugs rather than more expensive brand name drugs, to ensure more accurate payments for their services and keep health care costs down.

Summary

Disclosure of a physician’s relationship to imaging services is a good idea, as it will help to keep healthcare market focused.

The proposals focus on “Gifts” and not fee for services including clinical research, speaker fees, and consulting is a change from existing sunshine proposals in the house and senate versions.  But it also retains a vague sentence on “financial relationships” industry.

Discounts and rebates will be difficult to manage, as this is a very complex formula as discounts and rebates are often health care plan dependent.

Links to Proposal and Key Documents

White House Summary of Health Care Reform Proposal

White House Key Documents