Saturday, August 24, 2013

The Cloudy Aspects of the Physician Payment Sunshine Act

Another seemingly harmless bureaucratic initiative aimed at physicians sunk its taproot deep in the daily workings of medicine this month. The Physician Payment Sunshine Act promises transparency in all industry dealings with physicians by shedding "light" on the issue of payments to physicians from pharmaceutical companies and medical device manufacturers. In turn, it will save the system money, since all those freebies bestowed upon physicians when the corporate world came knocking can now be accounted for and physicians will be shamed into proper behavior.

Meanwhile, back at the drug company headquarters, some poor schnook gets to type all the names of the nurses and technicians that enjoyed their meal from the echo lab, cath lab, stress testing lab and were asked to place their name on a sign-in list so it can be entered on a multi-million dollar database designed to feed the government Big Data Bosom in the sky.  Busy doctors dart in, grab a bite, and go.

No need for them to sign-in.

You see, it's a bad marketing strategy to ask a doctor to sign a form as you peddle your product. And since no one is monitoring the accuracy of the sign-in sheets, as they have a few names to justify their effort and expense, well, they've done their part.

Why is this expensive data collection charade taking place? How much does it cost us? Does it change pharmaceutical tactics for marketing to doctors?   Of course not.  Yet there remain central planners who remain convinced (I mean, convinced!) that such monitoring works. It's a classic wish: just like the government's new HospitalCompare website, which promises to collect data on readmission, pneumonia, infection and death rates (with more to come) in the hopes that people will make "smart choices" about their health care. Do people really make their choice of health care facility based on such poorly-collected data placed on a website? I don't think so. Most people never think about their health until they have to arrive in an Emergency Room blindsided by an unexpected health crisis. They are not checking websites about payments to doctors - especially websites set up by the government. They want access to their local health care system and prompt, quality care. Yet were we are once again using Big Data filled with Bad Data as an ill-conceived and expensive social engineering exercise.  And this cost is passed on to health care consumers. In short, it's another perfect storm of wasted resources in the practice of medicine.

"But Dr. Wes, how can you say such a thing? Can't you see this Sunshine Act developed by Congress as part of the Affordable Care Act will disclose all of those greedy physicians who want to suck the health care system dry of all of that money? Aren't there benefits to the public transparency of these payments?"

The irony of this whole law is that Big Pharma and Big Medical Device Company already reports the money they give doctors to the government via the IRS in the form of a 1099-Misc. (Recall that the IRS is now firmly a part of our new health care law).  But instead of looking deep within the bureaucratic governmental morass for solutions to physician payments from industry, a new knee-jerk law was enacted to parade before the press to show how sincere the medical device companies and pharmaceutical companies are about the need for such transparency. Meanwhile, it's business as usual as backroom pricing of drugs and devices continues.

War room strategists have known this policy tactic for years: it's called diversion:  collect data on every $20 dollar physician lunch handout as our new breed of physician-employers (aka "Accountable Care Organizations) negotiate sweet deals with their insurance pals, prices of hospital system charge masters edge ever higher, drug prices and device charges continue to exceed tens of thousands of dollars thanks to Medicare payments, and insurance companies offer "health plans" rather than "insurance" to their policy holders.  And let's not even talk about the favors our Congressmen and Congresswomen are afforded.

But then again, better to put doctors in the limelight rather than speak honestly of the pricing games taking place behind American's backs, right?



Anonymous said...

This administration and in particular Obama with his statements about doctors cutting off patient's legs to make $50, $60 thousand dollars is enamored with besmirching physicians. The Sunshine Act is the continuation of the policy to blame doctors for doing their jobs.

I have warned the reps who visit me that I am not taking anything of value nor should they report me. For example, taking a re-print of a journal article is recorded as a $10 gift! Outrageous...

No dinners for this cardiologist or I will bring a bag lunch with me.

Furthermore, this administration is content to have us opposed to the care of our patients. Is it just a coincidence that we are all employed by the hospitals which are experiencing cuts based upon readmissions? Ultimately, it is the physician who decides whether a patient is readmitted within 30 days. This administration has taken to double the penalties for readmits which places more pressure on administrators who filter that frustration through to their 'employees'. Who do we work for...the patient or the hospital?!

All I can remember from the hotly contested debates in the House of Representatives over Obamacare is the congressman who said that the republican health care plan was to let grandma die.

The truth is that this administration has now forced physicians to send patients home to die rather than readmit and possibly lose their jobs (because their numbers suffer) or endanger the survival of the hospital.

Anonymous said...


As physicians increasingly become disempowered and marginalized in this cyclopean healthcare matrix, allow me to pose, in all seriousness, the following rhetorical question:

At what point does continued engagement in a "calling" become a mental illness?

Unknown said...

Dr Wes

Your piece on reporting physician lunches is perhaps the best you have written, and that is saying something.

It is only right that insurers now keep a list of names of those they hand pens to in Walmart to lure them into signing up with a given company.

Chip McCormick said...

It's not clear from this piece: do you think that doctors should be receiving benefits from pharma reps? I work in IT, not medicine, and we're required to report vendor donations for anything above the cost of a pen or mug and vendor-funded lunches would be out of the question.

What do patients gain from allowing pharma vendors to lobby physicians? I think though many think they are able to remain objective when choosing treatments and making purchases, it's difficult to avoid psychological pressure towards reciprocity.

medicine for real said...

Oh Wes, didn't your mother teach you that anything with the word "Act" in it does not bode well for the group being "Acted" upon.

Anonymous said...

It appears tedious, but this is a start in accountability. Everyone must endure the consequences of a few individuals. How many physicians actually invest in pharma company because a rep gave them a great lunch, and they are now inclined to prescribe this treatment inappropriately for every single patient to increase pharma company stock value?