Meeting this week in Chicago, the American Medical Association (AMA) House of Delegates overwhelmingly passed two crucial proposed changes to the Physician Payments Sunshine Act.
The first recommendation is for the Sunshine Act to include a reporting exclusion for educational items including medical textbooks and peer-reviewed journals.
The second is to limit the Sunshine Act reporting requirements to reporting payments and transfers of value over $100.
Both recommendations reflect sensible policies that embrace the transparency efforts of the Affordable Care Act, while recognizing that unduly burdensome requirements harm manufacturers, physicians, and ultimately patients.
Medical Textbook Exclusion
The Sunshine Act excludes from reporting “educational materials that directly benefit patients or are intended for patient use.” As we’ve reported, CMS apparently does not believe medical textbooks and journal articles fall within this educational carve out.
The American Medical Group Association (AMGA) urged AMA to work first with CMS to expand the Sunshine Act exception that covers educational materials to include medical textbooks and peer-reviewed journal articles provided to physicians. “[I]f no redress is obtained from CMS,” AMGA urged AMA to work with congress to legislatively expand the exception.
“Information contained within these non-exempted, peer-reviewed educational materials meets the highest standards of medical review,” AMGA states. “[P]eer review standards are rigorously applied within each journal and textbook protecting the integrity of its scientific articles by applying strict standards to ensure that there is no due influence applied by outside parties such as manufacturers.”
Furthermore, although CMS has noted that textbooks and reprints do not directly benefit patients, AMA has repeatedly stated CMS’ position is flawed. In recommending the textbook resolution, the House of Delegates stated they believe that “reprints and textbooks are education materials that directly benefit patients and should be excluded from reporting under the Sunshine Act.”
$100 Reporting Minimum
Currently, the Sunshine Act requires manufacturers to track and report any transfer of value to physicians over $10. The Medical Society of New Jersey (MSNJ) asked AMA to lobby Congress to amend the Act to limit transfer of value reporting to items with a value of greater than $100. The current tracking process “is unduly burdensome and expensive to both physicians and manufacturers, in terms of assessing and aggregating reportable values,” MSNJ states. “Unduly burdensome requirements to track minimal value transfers, monitor manufacturers’ reporting, and to correct any publicly reported inaccuracies, will be costly to physicians and will not facilitate the goal of the Sunshine Act.”
The House of Delegates responded that the current reporting requirement under the Sunshine Act “obscures significant and relevant transfers of value and increases the potential for publication of erroneous and inaccurate information.” They support efforts to improve transparency while reducing the cost and administrative burden of reporting, reviewing, and correcting a high volume of small dollar transfers. Thus, they recommend that the Resolution to increase dollar threshold be adopted.
Clearly, these issues are very important for stakeholders. Manufacturers and physicians are currently in the throes of the first year of Sunshine requirements, and the smallest transfers of value are proving to be the most tedious and time consuming to track and report.
By this vote the House of Delegates instructs the Washington Office of the AMA to work on these changes to the Sunshine Act. It shows that American’s physicians support transparency, but desire a reasonable policy that reports what is important and not incidental items.
AMA Sunshine Resolution – Medical Textbook