On October 7, Sen. Charles Grassley (R-Iowa) and Sen. Richard Blumenthal (D-Conn) introduced a bill that would expand the Open Payments reporting requirements to include nurse practitioners and physician assistants. Currently, to comply with the Sunshine Act, pharmaceutical and medical device manufacturers are required to report payments and other transfers of value to physicians and teachings hospitals. While the definition of physician is broad—and includes doctors of medicine, osteopathy, dentists, podiatrists, optometrists and chiropractors who legally authorized to practice by a state—the law currently does not cover NPs or PAs.
Proponents of the change to Open Payments, including ProPublica, have argued that these professionals are able to prescribe medicine and should be included in the transparency language just like doctors.
Provider Payment Sunshine Act – S.2153 – A bill to amend title XI of the Social Security Act to require applicable manufacturers to include information regarding payments made to physician assistants, nurse practitioners, and other advance practice nurses in transparency reports submitted under section 1128G of such Act.
Currently, only a summary of the bill is available; we will add specific of the bill as they are released.
The Senators’ bill comes after Connecticut passed a similar law in 2014 that they have since delayed to 2017. Introduced as part of a bill giving Advance Practice Nurse Practitioners (APRNs) the opportunity to practice independent of physicians if they met certain requirements, Connecticut added a transparency provision to include this new set of covered recipients above and beyond Federal Open Payments requirements.
Perhaps spurring the Federal discussion, the U.S. Attorney’s Office of the District of Connecticut recently announced that an APRN practicing in the Connecticut admitted to receiving $83,000 in kickbacks—mostly as a speaker at dinner programs—from a drug manufacturer. The DOJ stated that Heather Alfonso was a “heavy prescriber” of a drug used to treat cancer pain. They noted that a review of Medicare Part D prescription drug events for prescribers of the drug showed that Alfonso was responsible for more than $1 million in claims and was the highest prescriber of the drug in Connecticut. However, the government found through interviews with Alfonoso’s Medicare Part D who were prescribed the drug, revealed that most of them did not have cancer, but were taking the drug to treat their chronic pain.
Transparency advocates have pressed for a more expansive “covered recipient” definition in several public forums. Last month MedPac staff suggested expanding reporting to other providers, though the members of MedPac were less enthusiastic. In February, the National Coalition on Healthcare recently held a discussion on the Physician Payments Sunshine Act that featured insight from Senators Grassley’s staff. There, Adriane Fugh-Berman, MD, associate professor of Pharmacology at Georgetown and alternative medicine specialist, whose organization,PharmedOut, advocates against pharmaceutical marketing influence in medicine, stated the Sunshine Act is not doing enough to weed out pharmaceutical company influence. Open Payments “only picks up about 20 percent of what is required to be reported,” she stated (though it is difficult to understand where her source comes from). “Some states or non-states [referring to DC’s AccesRX Act] have reporting laws that are even more stringent, and I would make a plea for keeping them.” Additional requirements imposed by these laws include reporting payments to nurse practitioners and physician assistants. Fugh-Berman also points to the influence of social workers and receptionists, and even a doctor’s social contacts.
| Massachusetts 2013 Payment Reporting | |||
| Advanced Practitioners | Total | #of Payments | % of Total |
| Nurse Anesthetist (RN/NA) | $15,057 | 76 | 0.04% |
| Nurse Midwife (RN/NM) | $3,427 | 27 | 0.01% |
| Nurse Practitioner (RN/NP) | $292,888 | 1,015 | 0.81% |
| Physician Assistant | $178,781 | 635 | 0.49% |
| Total Advanced Practitioners | $490,153 | 1,753 | 1.36% |
| Total Payments All Practitioners in Massachusetts | $36,155,332 | ||
*source Massachusetts Manufacturers Payment Reporting Database 2013
This bill is important to watch for manufacturers who may need to expand their reporting requirements if passed. However, in our analysis of Massachusetts physician payment reports (which has had Sunshine-like requirements for a wide range of recipients for several years), we found that PAs and NPRNs together received less than 1.4% of the share of payments for Massachusetts in 2013, the last year of available reporting.
It is not clear that one example of a provider gone amok would have been exposed any sooner within the 15.7 million records that Open Payments has amassed in the last 17 months of public reporting, or that it would have been easier to find the bad apple amongst all that data. With the reams of data currently on Open Payments, adding NP’s and PA’s may only add more confusion to an already crowded database.
Link to Bill Language: Provider Payment Sunshine Act
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