Hail the Sunshine Act (?)

June 8, 2013

Do you want to know if your doctor has been eating pizza for lunch that was purchased by Pfizer as she listened to a drug rep describe a new medication? Do you want to know if your endocrinologist has been paid $1,500 to give a brief talk about a new injectable diabetes medication to his colleagues as they gobble down filet mignon? If the answer is “yes,” then you are in luck.

As the August 1st, 2013 deadline to start reporting information about these sorts of transactions approaches, doctors and hospitals are reevaluating whether a free tray of chicken salad wraps is worth the scrutiny.

The Sunshine Act, a provision of the Affordable Care Acclownsinmedicinet (aka Obamacare), requires companies that make drugs, medical devices, and biological medicines to report payments and items of value given to physicians and teaching hospitals. (specifics outlined by NEJM and AMA)

Additionally manufacturers and group purchasing organizations must report certain ownership interests held by physicians and their immediate family members. It seems like physicians who own stock in a publicly traded pharmaceutical company do not have to report these shares, as they are generally available to everyone and are considered an “exempt” interest. But other terms of ownership and investment interest must be disclosed, including the dollar amount.

A transfer of anything between a company and a physician that has a value above $10 must be reported. Cumulative gifts totaling $100 or more over a year must be reported.

One way a sneaky physician might find a loophole in this regard would be to ask the drug rep who comes to the office for a lunch time meeting to bring just one hot dog, valued at $9.99. This would fly under the radar… at least 10 times per year – but if the total cost of the hot dogs brought into the doctor’s office exceeds $100 for the year, said hot dogs must be reported. One could then log on to the Medicare website and see how the 11 hot dogs your doctor ate over the year totaled $109.89, which carries multiple degrees of shame.

The Sunshine Act will expose or stop many physicians from making additional money through relationships with manufacturers that represent a conflict of interest.

It will also represent another dreadful use of the word “sunshine,” and makes for great irony as our government increasingly operates in darkness.

The threat of public shame and public misunderstanding will also create fear among physicians, and new treatments and medications will go unnoticed without the occasional lunch used by drug reps and physicians to communicate.

I’m looking forward to less patients assuming I go golfing for free, or thinking I get taken to Las Vegas for a free convention every year.  This has been outlawed for some time.

Office morale will plummet in many locations that used to host drug reps for lunches, occasionally or daily. The medical assistant who used to look forward to getting a free eggplant parm with arugula salad once a week (as her doctor learned about a new blood pressure medication) may now be upset. A lot of mom and pop restaurants will see fewer business lunches purchased by drug reps, and more fancy dinner venues will see a decline as well.

In any other facet of the American economy, the “business lunch” is revered as an opportunity for communication, networking, and an exchange of new ideas. In medicine it has been cast as a seedy chance for manipulation, kickbacks, and brainwashing, and is now subject to the sanitizing UV radiation of “sunshine.”

If we as physicians are to be held to such monastic, ascetic terms of engagement with the business community, then fine. I’m all for keeping drug reps carrying trays of chicken nuggets away from the office.  I’m all for those few specialists and physicians who are much too cozy with pharmaceutical companies getting the public scrutiny of their speaking fees and other arrangements. BUT THEN EVERYONE ELSE BUTT OUT, TOO.

Insurance companies paying CEO’s hundreds of millions, malpractice clients and their lawyers getting paid millions, overpaid health care administrators emulating corporations, and third party profiteers of all stripes… EVERYONE OUT.

The examining room should be about a doctor and a patient, with the unfortunate reality of the economic exchange feeling no more corrupt than payment for a bag full of groceries.

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