Physician Payment Disclosure Bill Should Include Other Entities – MedPAC

The Medicare Payment Advisory Commission is recommending a more comprehensive system for reporting pharmaceutical industry payments than the one proposed in legislation pending before Congress.

The Physician Payments Sunshine Act, first introduced in the Senate by Chuck Grassley, R-Iowa, and Herb Kohl, D-Wisc., calls for a publicly available database containing physicians' names, payments made to them by companies and the purpose of those payments (¹ (Also see "Sunshine Bill Gains Momentum From PhRMA But Time May Be Running Short" - Pink Sheet, 26 May, 2008.), p. 17).

At a Sept. 4 meeting in Washington, D.C., MedPAC recommended taking the plan further in not only requiring physicians, but also requiring academic medical centers, continuing medical education organizations and patient and physician advocacy groups, to report payments greater than $25 from device, drug and supply companies.

Industry should report everything from gifts, meals and entertainment to honoraria, consulting and speakers' fees, education, research, investments and product royalties, MedPAC said.

The commissioners embraced full disclosure, but disagreed on whether reporting requirements should cover payments made to entities other than physicians.

"If the goal is to ensure that physicians aren't being unduly influenced, knowing what goes to CME isn't going to do it for you," said MedPAC commissioner Nancy Kane, Harvard School of Public Health. "I wouldn't broaden the reporting requirements to every intermediate organization that gets the money because you can't link it back down to the individual doctor."

The commissioners also re-evaluated whether the $25 threshold proposed in the Sunshine bill was too low to provide useful information on financial relationships.

"I worry a little bit about having a threshold that is too low and that we get too much information, and the important information is lost," health policy consultant William Scanlon said.

"We demean lots of professions to think they're going to be influenced by a hamburger and a free pen," added Robert Reischauer of The Urban Institute.

The public database should be Internet-accessible, clearly define the category of each payment and should allow users to search for payments by type, amount, physician and manufacturer, the commission agreed.

"It's not all about pointing out the bad people doing the bad things, or even some people in the middle who do not realize they're doing bad things," said Mitra Behroozi of welfare trust fund 1199SEIU Benefit and Pension Funds. "One of the purposes is just for researchers to examine the impact of payments."

Closing The Trade Secret Loophole?

Industry fears public reporting of physician interactions will jeopardize trade secrets, such as consulting or research arrangements. Some state disclosure programs allow companies not to report payments they believe would reveal trade secrets. A number of laws and bills under consideration at the state level contain varying reporting thresholds and exemptions (² (Also see "Marketing Oversight By States Creates Multiple Compliance Standards For Firms" - Pink Sheet, 1 Sep, 2008.), p. 19).

MedPAC proposed delaying the disclosure of payments related to a new product either until a clinical trial is registered on NIH's Clinicaltrials.gov Web site, or until FDA approves the product, but no later than a set amount of time after payment is made, such as two years.

Reischauer remains wary of letting firms "withhold information that's deemed by them to be proprietary. That strikes me as a loophole that you could drive an aircraft carrier through."

"Better to be non-specific about what the purpose of the grant was than to not disclose it for a few years," he said.

- Jessica Bylander ([email protected])