Recent articles by ProPublica and NPR spotlight the absence of reporting requirements by pharmaceutical companies of their payments to nurse practitioners and physician assistants under the Affordable Care Act’s (ACA) Physician Payment Sunshine Act. The two web articles reference a case in which a Connecticut nurse practitioner pled guilty to accepting $83 million in kickbacks “from a drug company in exchange for prescribing its high-priced drug to treat cancer pain. In some cases, she delivered promotional talks attended only by herself and a company sales representative.” Because the law does not require reporting of industry payments to nurse practitioners such as this Connecticut provider, if not for the lawsuit, the public might have remained unaware of such payments to her and others like her.
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To illuminate potential conflicts of interest in medical practice, Congress passed the “Physician Payment Sunshine Act” as part of the ACA. The Sunshine Act requires drug, biological and medical device companies that participate in U.S. federal health care programs to report to the federal Centers for Medicare and Medicaid Services (CMS) certain payments and items of value given to physicians and teaching hospitals. Providers and hospitals included in reporting under the Act are able to review their own reported information and respond within 45 days to dispute any inaccuracies before the information is published each year. (Providers who miss that window can still correct reporting errors for later publication.)
The federal Centers for Medicare and Medicaid Services (CMS) publishes online statistics summarizing information reported under the Sunshine Act, including a search feature that enables users to view reported payments to individual physicians and teaching hospitals. Current figures on the CMS Open Payments Data webpage show $6.49 billion in payments to 607,000 physicians by 1,444 companies in 2014. According to CMS, more than $4 billion of those payments were paid for research grants, or associated with royalties or licenses.
It is common practice in the pharmaceutical industry for companies to pay physicians, teaching hospitals and other healthcare providers to develop, improve and promote their products. Such compensation can be a welcome source of income for healthcare entities and for individual providers, especially those at academic medical centers, who may earn lower salaries than providers in the private sector. The intent of the Sunshine Act is to shine the light of public awareness on industry payments to physicians, to avoid or mitigate conflicts of interest or bias in the work of health researchers and practitioners.
It has been reported that most expenditures reported to CMS by the pharmaceutical industry in 2014, however, were for individual expenditures of $20 or less.
Of course, physicians are not the only health care providers who write prescriptions in the U.S. According to the ProPublica article, nurse practitioners and physician assistants wrote about 10 percent of the nearly 1.4 billion prescriptions in the Medicare Part D program in 2013. The article references a 2010 publication by Elissa Ladd in the American Journal of Managed Care, reporting a survey of 263 nurse practitioners about their interactions with the pharmaceutical industry. In that article, ninety percent of nurse practitioners surveyed believed that it was acceptable to attend lunch and dinner events sponsored by the industry. Pharmaceutical industry trends in soliciting and engaging nurse practitioners and physician assistants in ways similar to industry interactions with physicians could result in support to broaden the scope of the Sunshine Act to require reporting as to those professionals.
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