Most practice managers and physicians have probably heard of this law by now. We wanted to take a few minutes and help clarify or enlighten groups about their responsibilities and risks associated with this law. The Physician Payments Sunshine Act (PPSA) was enacted as part of the Affordable Care Act (Section 6002). The objective of the PPSA is to provide transparency as it relates to contributions made to physicians by pharmaceutical companies, medical device manufacturers and group purchasing organizations(GPOs). Covered entities under this law include: Teaching Hospitals, Physicians, Chiropractors, Dentists & Optometrists.
As a covered entity, manufacturers are required to submit a report to CMS that details the value of all contributions you have received. While physicians are not “required” to do anything under this law, tracking contributions is advised to ensure manufacturers accurately report contributions to CMS. Why you ask? Well, CMS will aggregate the data and publish an individual physician report on a publicly available website. This report can and will be viewed by patients, watchdogs, litigators and the press which could be used to raise concerns about potential conflicts of interest.
What is considered a transfer of value?
- grants
- research
- education
- direct compensation for serving as faculty or speaker for CME event
- charitable contributions
- space rental or facility fees (teaching hospitals only)
- payments to an entity or individual at the request of a CE
- entertainment
- food and beverages
- travel and lodging
- gifts
- consulting fees
- compensation for other services
- honoraria
What is excluded from the report?
- Staff lunches if the physician does not attend unless the lunch was requested by the Physician
- Transfers of less than $10
- CME events
- Not reportable unless amounts to more than $100 annually
- Pens, papers and other small items (less than $10) handed out at conferences or large scale events are excluded from the $100 aggregation requirement
- Aggregate across all categories (food, entertainment, products etc.)
Who is excluded from the report?
- Physician Assistants
- Nurse Practitioners
- Residents
What should you do?
- Develop internal tracking mechanisms to accurately attribute the transfers of value (e.g. lunches, entertainment etc.)
- Create a reporting template for each physician and track payments individually
- Distribute reporting templates to each physician to track transfers of payments that occur outside of the practice (i.e. speaking engagements, travel, research)
- Develop sample talking points physicians may use with patients to inform them of their relationships with manufacturers/GPOs
- Ensure the physician’s information is updated in NPPES to facilitate communication with manufacturers regarding transfers of value.
- On March 31, 2014, physicians should begin reviewing manufacturer/GPO reports on the Open Payments Website (Access Here)