The Physician Payment Sunshine Act: Are Your Doctors Ready@f9

Senior Director of Marketing

The Patient Protection and Affordable Health Care Act (PPACA) includes section 6002, which is also known as the Physician Payment Sunshine Act. This section requires pharmaceutical, medical device, biological, and medical supply manufacturers to report to the U.S. Department of Health and Human Services (DHHS) any “payment or other transfer of value” to physicians and teaching hospitals. While the final regulations for this act were released in the Federal Register in February 2013, preparing physicians adequately can be challenging for healthcare organizations. This article discusses a few implications of this act and how your healthcare organization can better prepare physicians to manage the payment reports shared with the government.

Implications of the Physician Payment Sunshine Act

In accordance with the Sunshine Act, data on payments and gifts made to physicians and teaching hospitals by medical device and pharmaceutical companies must be publicly available on a searchable federal database, which will be available starting in September 30, 2014. The good news for hospitals and physicians is that most of the burden of complying with the Act lies with medical device and pharmaceutical companies. There are still a few things, however, that your healthcare organization needs to consider to prepare for the Act. Under the Sunshine Act, physicians have the right to review their reports and challenge reports that are false, inaccurate or misleading. The timeframe for initiating disputes and having data corrected or publicly marked as disputed, however, is extremely limited.

The American Medical Association (AMA) has created a Sunshine Act toolkit with additional information to help physicians prepare for the Act. According to AMA’s website, physicians need to take the following three steps in 2014:

  1. Complete the Centers for Medicare & Medicaid Services (CMS) e-verification process via the CMS Enterprise Portal (EIDM).
  2. Register with CMS’ Open Payments system, also via EIDM.
  3. Review and dispute data by December 31, 2014, but it will not be flagged in the public database until 2015.

Research Shows Physicians Could Be Unprepared

Although the survey results were released in February 2013, MMIS’ third annual survey of doctors and their knowledge of the Sunshine Act found that “over half [of physicians questioned] admitted they didn’t know that the law requires pharmaceutical and medical device companies to report on expenditures annually, without physician review of the data to correct any inconsistencies or errors, prior to submission to the government.” While physicians could be much more informed by now, it’s important that they take action to stay informed on what will be reported when the data becomes public on September 30, 2014.

Helping Physicians Prepare for the Sunshine Act

In the June 2014 edition of Compliance Today, Jillian Watts recommends offering live presentations to educate physicians on the Physician Payment Sunshine Act. Live presentations are a great way to inform physicians because it enables them to interact and ask questions. While physicians are not required to register with or send any information to CMS’ Open Payments system, it’s highly recommended that they become familiar with the information that will be reported about them. CMS has provided a five-page Open Payments (Physician Payments Sunshine Act), which is a great resource to share with your physicians. There are also free resources available to help educate physicians on the Sunshine Act. The American Medical Association, for example, offers a free webinar titled Physicians Preparing for the Sunshine Act: What You Need to Know and How to Prepare.

Now that the Physician Payment Sunshine Act is here, physicians are encouraged to participate in CMS’ Open Payments program to review what’s reported about them. By providing them with the resources and proper training, healthcare organizations can empower their physicians to ensure the information reported to the government is correct.