APRIL 2012 :: Cover Story

Health Care Transparency Law Exposes Industry Relationships with Physicians

Published Saturday Mar 31, 2012

Michaeline Daboul

Michaeline Daboul

What would you do if information about your relationships and income were published in an online searchable database for the entire country to see? What if the information published was incorrect and you did not have an opportunity to review the data prior to publication in the public domain?  Will your relationships be damaged?  Will marketers incessantly contact you based on your public profile?  Will your family and friends treat you differently based on the information presented?

In early 2013 physicians, health care providers, health care organizations, such as teaching hospitals and research institutions, will have to deal with the public scrutiny that comes along with the public disclosure of all payments and transfers of value (“spend data”) made by pharmaceutical, medical device and biopharmaceutical companies to the health care providers and institutions.  Yes, you read that correctly!

As part of the Patient Protection and Affordable Care Act (PPACA), otherwise known as “Obamacare,” the Sunshine Provisions require all payments and transfers of value made to physicians and teaching hospitals to be reported to the Center for Medicaid and Medicare Services (CMS) by pharmaceutical, medical device and biopharmaceutical companies. During a 45-day review period, physicians will be able to review and dispute individual transactions with the companies that reported the data. However, according to the proposed rules, in the event the parties are unable to resolve the dispute, both the original data as well as the disputed data must still be reported to the public database during the dispute resolution process.  As you can imagine, incorrect information, whether under dispute or not, is misleading and may generate ill will between industry and the physician as well as call into question the physician’s ability to provide conflict-free health care to their patients.

Currently CMS has not provided guidelines or requirements for the proactive sharing of spend data with physicians or institutions. Rather, through the proposed rules, CMS has strongly encouraged industry to proactively share the information with their customers to ensure submission of accurate data. Sounds like a good idea, but how will the largest pharmaceutical and medical device manufacturers each share over 4 million spend transactions with their customers?  How will inquiries be handled?  How will disputes be resolved?

At the present time, most large, medium and small companies do not have a notification and dispute resolution process in place.  Should they build a system internally? How will they encourage their physician and industry customers to access and review the data? Sounds like a pretty complex problem for every one involved.  I call this the Health Care Transparency Ecosystem, and solving the pro-active notification and dispute resolution process will be one of the major challenges for industry.  It is imperative for industry to continue the collaborative relationships with their customers that result in new innovation and improved patient care. Similarly, it is important for physicians who want to review data prior to public disclosure, and academic medical centers who need to manage the conflict of interest (COI) between industry and their physician staff.

In order for transparency to truly work and the intended effect of the US government’s Sunshine Provisions to provide the intended benefits each of the ecosystem partners must be satisfied and participate in a win-win solution.

One possible approach would be to engage academic teaching institutions to adopt best practices to educate physician staff members on the new transparency and COI requirements.  Once educated, physicians will be more willing to participate in managing and monitoring their personal COIs with industry relationships and in time will encourage industry to share every spend transaction with the physician on, let’s say, a monthly basis. As physicians and academic institutions incorporate the review and monitoring of spend data they will incorporate best practices to communicate errors to industry prior to reporting. Industry needs to comply with the law and to keep their customers on good terms, which will force them to incorporate new methods to aggregate, track and report data as well as incorporate new methods to pro-actively share data with their customers on a regular basis.

The Health Care Transparency Ecosystem requirements and the impending Sunshine Provisions of the PPACA are a perfect breeding ground for innovative companies to utilize current technology to provide solutions for each one of the ecosystem partners.

For more information on MMIS, Inc. contact:

* Website: http://www.medispend.com/http://www.mmis-inc.com/
* Contact: Michaeline Daboul – President
* Email: mdaboul@mmis-inc.com
* Twitter: @mmispresident
* LinkedIn: www.linkedin.com/company/mmis-inc.