Sunshine Act

What the “Sunshine Act” means for your practice

The "Sunshine Act" is shining a light on transparency in industry-doctor relations—and optometrists have an important role to play.

"It certainly behooves ODs to review what's being made available ... to ensure its accuracy and address any concerns."

The Affordable Care Act authorized Sunshine Act rules to make the public aware of any financial transactions taking place among certain members of the health care industry. The Centers for Medicaid and Medicare Services (CMS) is overseeing this "Open Payments" reporting system.

Any gifts, payments or other transfers of value made to physicians (including ODs) and teaching hospitals by the manufacturers of pharmaceuticals, medical devices and medical supplies now require public reporting.

Certain Group Purchasing Organizations (GPOs) must report ownerships or investments held by physicians or their immediate familes, payments and other transfers of value from the GPO to a physician with an ownership or investment interest in the GPO.

The goal is to inform the public of potential conflicts of interest, says Chris Wroten, O.D., a member of the AOA's Federal Relations Committee.

The burden of tracking and reporting falls on manufacturers or GPOs. But ODs and other physicians have the opportunity to review and correct any information in these reports about gifts or payments they received.

ODs in these situations would most often be dealing with manufacturers, but some will be affected by GPOs—and not be aware of it, Dr. Wroten says

  1. Why you should get proactive

    Patients and the general public will be able to view these reports. "If there's been a legitimate transfer of value of a significant amount, the appearance could be that there's some form of external influence on the doctor's decision making," Dr. Wroten notes. "It certainly behooves ODs to review what's being made available to the public and to their own patients to ensure its accuracy and address any concerns."

  2. What can be reported—and when

    "Transfers of value" may include lunches a pharmaceutical or contact lens company holds in an OD's office for staff or certain continuing education events sponsored by manufacturers.

    Other transactions may involve travel expenses, charitable contributions from industry, food and beverages, consulting fees and speaker honoraria. Gifts under $10 are not reportable, Dr. Wroten says.

    CMS required manufacturers to begin collecting data Aug. 1, 2013. They must report their data to CMS annually by March 31 of each calendar year. The first group of reports under the Open Payments program are scheduled to be available to the public on CMS's website on Sept. 30, 2014.

  3. How to find out if you're in a report

    CMS is anticipating a 45-day window for practitioners to review reports for accuracy. This window will occur after reports have been posted for review but before they go public.

    The AOA has been encouraging ODs to register with CMS's Enterprise Portal. Doing so will allow them to receive electronic notifications when relevant data has been posted for review. The alternative is to manually check the CMS website, but that comes with a risk of missing the review period, Dr. Wroten cautions.

  4. How to change errors

    If there's a discrepancy between transfers of value and what has been reported, an OD must contact the manufacturer involved to correct the error. That manufacturer will then need to amend its report to CMS.

    For example, if an OD lectures on behalf of a pharmaceutical company or contact lens manufacturer, the value transferred in the form of honoraria, travel or other related expenses is reportable. If the manufacturer over-reports what was actually paid, the OD should inform the manufacturer of the error.

    Ultimately, it's up to the two parties to discuss and resolve any discrepancies, Dr. Wroten says.

May 8, 2014

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