Physician Payment Sunshine Act: Doctors Bracing for Increased Public Scrutiny

The Wall Street Journal
recently reported on the Physician Payment Sunshine Act. The Journal noted that doctors are “bracing” for increased “public scrutiny of the payments and gifts they receive from pharmaceutical and medical-device companies as a result of the new health law.”

As we have reported numerous times, the Journal broadly summarizes the Sunshine Act: “Starting this month, companies must record nearly every transaction with doctors—from sales reps bearing pizza to compensation for expert advice on research—to comply with the so-called Sunshine Act provision of the U.S. health-care overhaul. The companies must report data on individual doctors and how much they received to a federal health agency, which will post it on a searchable, public website beginning September 2014.”

Doctors worry the public will “misinterpret the information.” Others fear: “patients will view the payments as tainting their medical decisions, and will lump together compensation for research-related services with payments of a more promotional nature.”

Dr. John Mandrola

The story notes the experience of one doctor, John Mandrola, a cardiologist in Louisville, KY. Dr. Mandrola says he has been paid a total of: “$1,500 to $2,000 this year by medical-device makers for speaking engagements.” Knowing that such transactions will become public has caused him to be more cautious about what fees to accept, he said. He avoids industry reps visiting his office, believing he can get information on new drugs elsewhere.

“I’ll continue to weigh the benefits and the negatives, and I think the Sunshine Act and the public reporting of all this stuff makes us think about that,” said Dr. Mandrola. “And I think that’s a good thing.”

Dr. Mandrola addressed the benefits of added transparency, but notes that the disclosures: “could squelch legitimate interactions—for example, when doctors receive consulting fees to help companies develop drugs and determine their best use.”

“I don’t think all physician-industry interaction is bad,” he said.

Dr. Mandrola’s follow-up

Posting on MedCity News, Dr. Mandrola added more context to his quotes in the Wall Street Journal. Dr. Mandrola writes:

“Doctors are a conservative lot (a good thing for patients), so yes, it is likely that things will change. Concern over perception will surely decrease physicians’ interactions with industry, both the useful and not so useful ones. Do we really want the industry responsible for innovative medical products blowing money on keeping spreadsheets of how many free burritos someone is getting?

The effect on physician education might suffer. Though the Ben Goldacre’s of the world rightly emphasize bias when industry entwines itself with medical education, I can attest to have learned a lot from industry-sponsored programs–like the echo conferences a decade ago. And this too: one thing that happens when industry sponsors a learning session is that doctors come to it. They talk; they share cases; they come together face-to-face. Such interactions are critical. Will the disappearance of sponsored sessions decrease the amount of face-to-face learning? Yes it will. Maybe social media can fill the face time void. And maybe not. A chilling effect on physician education should not be minimized.

There is one exception to the Sunshine Act that deserves emphasis: If industry gives money to a medical society as an unrestricted grant, the society can then use the money to pay speakers without disclosure. As long as the money is not ear-marked, no disclosure is required. Influence leaders, therefore, can continue to be paid for influencing. If the ultimate goal of the Sunshine Act is to improve transparency or perhaps even decrease utilization of expensive medical care, this loophole seems an important one.

And the final irony: Deep down, I believe that less is more in medical care. Changing the culture of American Medicine from one that disrupts so much to one that disrupts a little less will ultimately improve societal health. Alas, the problem is that it’s all so nuanced. The Sunshine Act may help sharpen some lines, but in the care of other humans, the lines will always remain blurry.”

Other drug and device makers

The Journal further notes that several drug and device makers have been posting physician-payment data online for the past few years. Some U.S. states already require companies to report such information. But the Sunshine Act will significantly widen the scope because it applies to most companies—any company whose products are covered by Medicare—and the government’s launch of the database could draw greater public attention.

Richard B. Aguilar, a diabetes-care specialist, received a total of $42,339 from Lilly for the first three months of 2013, according to Lilly’s online payment database. Dr. Aguilar, who has a private practice in Downey, Calif., said he speaks about Lilly drugs at programs to teach other doctors, and the information is consistent with the FDA-approved prescribing labels. He says the payments are fair compensation for his expertise and travel. Dr. Aguilar plans to continue serving as a paid speaker, but he says other doctors are increasingly opting out of attending or speaking at such programs for fear of what the public will think about the payment disclosures.

Dr. Aguilar said he hopes the public would see the value of physicians learning new information about drugs from an expert at speaker programs, rather than having to rely upon their own educational resources to keep current. “This, in essence, is reducing the number of valuable expert educational speakers who might otherwise have provided teaching and experience to many health-care providers,” he said.

Some doctors fear the payment data will be inaccurate and could mislead the public about the nature of their relationships with the industry. Gary M. Cowan, an ophthalmologist in Fort Worth, Texas, said he has occasionally attended company-sponsored dinners to hear a lecture from an expert in his field. He plans to monitor the payments that companies report in his name.

“I think it behooves every physician to look and see what’s said about him,” he said.