CMS to Enforce Payment Transparency Law

    The Centers for Medicare & Medicaid Services (CMS) will explain the provisions of the National Physician Payment Transparency Act, also known as the Open Payments Act or Sunshine Act, in a teleconference at 1:30 pm CDT on Wednesday, May 22. The act is part of the Patient Protection and Affordable Care Act and requires manufacturers of drugs, medical devices, and biologicals that participate in federal health care programs to annually report payments and items of value they give physicians and teaching hospitals.

    The law, which CMS will begin enforcing Aug. 1, also requires manufacturers and group purchasing organizations to report ownership interests held by physicians and their immediate family members. Most of the information contained in the reports will be available on a public, searchable website. Physicians can review their reports and challenge them if they are false, inaccurate, or misleading.

    In February 2012, the Texas Medical Association, the American Medical Association, and state and national medical societies across the nation wrote CMS officials a letter expressing concerns with the rule implementing the law and proposing several amendments. The letter said organized medicine believes CMS "exceeded its statutory authority with regard to at least one significant provision and misconstrued Congress' overall intent and statutory requirements in other areas. While we support the underlying goal of enhancing transparency, we believe the proposed rule, if implemented without significant modifications, will result in the publication of misleading information and impose costly and burdensome paperwork requirements on physicians while shedding very little light on actual physician-industry interactions."

    As a result, AMA says CMS modified the final regulation so that:

    • Continuing medical education (CME) that complies with certified or accredited CME standards governing independence from industry is excluded from reporting.
    • The time physicians have to challenge inaccurate or misleading reports was expanded. Physicians now may seek corrections and challenge the accuracy of the consolidated reports at any time for two years.
    • If a physician disputes information contained in a report, it will be flagged in the public registry as disputed if the manufacturer and physician do not resolve the dispute.
    • Physicians, teaching hospitals, and industry have six months to prepare before industry is required to begin collecting information on Aug. 1, 2013.
    • Medical residents are excluded from the reporting requirement.

    AMA posted a webinar on the law on its website. Physicians Preparing for the Sunshine Act: What You Need to Know and How to Prepare gives a basic overview of the financial interactions and ownership interests that will be reported, the excluded financial interactions, and steps physicians can take between now and Aug. 1. It also lists key dates you need to know and answers frequently asked questions.


    Action, May 15, 2013


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