Sunshine Act provision adds transparency
New light shed on providers receiving government dollars
Recent public comment on changes to the guidelines on the 2010 Affordable Care Act’s physician payments provision, the so-called Sunshine Act, brings to light a number of questions from both sides of the issue of making public the healthcare-related financial dealings of doctors and hospitals who receive Medicare and Medicaid funding.
On one hand are about 1,500 drug and medical device manufacturers and 420 group purchasing organizations. As the federal disclosure rules are drafted, industry is wrestling with just how it is to collect and make public the information, and to what level of detail it is required to collect it.
On the other hand are 669,000 doctors and 1,100 teaching hospitals. They worry that current guidelines fail to provide both an adequate timeframe and system by which doctors may verify the accuracy of information industry posts before it is released to the public.
The questions – and the potential fines from the Centers for Medicare & Medicaid Services of up to $1 million per year – don’t lend themselves to easy answers. But, industry experts say, the healthcare finance community need not sit idly by, waiting for clarification. In fact, the sooner more detailed financial information is gathered, the better.
“I’d start asking (physicians) questions now and require them to disclose their financial relationships,” said Matthew Albers of the healthcare practice group of Vorys, Sater, Seymour and Pease in Cleveland. “Ask and re-ask questions, at least bi-annually, as part of credentialing, if not more often. For hospitals, there’s no downside to having the information on file. For doctors, assuming everything is on the up-and-up, there’s no downside to disclosure.”
The way Micaeline Daboul sees it, waiting for final rules only heightens the chance for trouble.
“If I were managing say 1,400 physicians at a teaching hospital this would absolutely be one of the financial points I review every month,” said Daboul, president and CEO of MMIS, a compliance software company based in Portsmouth, NH that has developed web-based tools to help industry track and aggregate their expenditures. “I’d want to know (their) relationships with industry, and how that information is going to be perceived in the public domain. If you don’t know that in a proactive manner, you might as well hire a huge public relations agency to handle the mess that is going to come down the pike. You need to be proactive in protecting those relationships.”
It’s also important that all parties involved must be mindful of consistency, said Kenya Woodruff, an attorney with the healthcare practice in the Dallas office of Haynes and Boone.
“You want the finance side of the house to make sure to check any reporting with their compliance folks,” Woodruff said. “You could be creating issues for yourself just in the way you are reporting these dollar amounts. Finance and compliance reports need to be in synch and organizations need to be aware of the potential liability that may flow from the reporting.”
