Getting a sunburn from the Sunshine Act

When it passed the Affordable Care Act (and the companion Physician Payment Sunshine Act), Congress tasked physicians with one of the summer’s more frustrating activities, and this one is turning out to be more onerous than expected.

Robert M. Wah, MD, the newly installed president of the AMA, used his new platform last week to send an urgent message to physicians: Take the time to register, review and dispute any inaccurate information contained in the Open Payments System before the August 27 deadline. The database was created in response to the Physician Payment Sunshine Act and is intended to make public any financial agreements between physicians and pharmaceutical and medical device companies.

Pharmaceutical and medical device manufacturers had until March 31, 2014, to report payments of more than $10 made to physicians between August 1, 2013, and December 31, 2013. Physicians were given a period of 45 days, ending on August 27, to dispute any false information. CMS intends to make the data public on September 30.

Physicians, however, are currently unable to access the Open Payments verification portal. ProPublica, the public-interest journalism site, has been watching the project closely, having tracked financial ties between physicians and medical companies since 2010. Initially, the site reported that physicians without any payments attributed to them were getting a confusing “error” message. Based on another ProPublica report, CMS suspended the verification system while it checked on whether the site had erroneously attributed payments to the wrong physician but the right name. The system reportedly has been down since the evening of August 3, 2014.

The AMA, the ACR and 110 other medical organizations and societies recently sent a letter to CMS Administrator Marilyn Tavenner asking that the deadline be extended and physicians be given more time to review the information that has been reported about them. The letter made several other recommendations, including that textbooks, reprints of articles in peer-reviewed clinical medical journals and other services used to educate physicians be granted exclusions.

For more years than I can account for, medical companies and professions have shared a beneficial symbiosis in that industry underwrites a good deal of continuing medical education. Of course there is a kernal of self interest in all such acts of altruism, but that is how the world works: Unless the balance of power is upset, nothing more nefarious than the associated goodwill glow is desired. Money, of course, is a good way to upset that balance of power, but $10 is unlikely to influence anyone but a small child. At a time when medicine is changing more rapidly than ever, taking patient centricity too far potentially could have unintended negative consequences for patient care.

It’s probably not a good idea to wait and see if that extension is granted: Based solely on the government’s track record in the construction of web sites, you'd be well advised to take an hour or two of the waning days of summer and check the accuracy of your listing—when CMS finally enables the verification site again.

Assuming the site will be brought back online, the AMA has provided the following guidance:

• Step 1: Complete CMS' e-verification process
• Step 2: Register with CMS’ Open Payments system
• Step 3: Review and dispute data