The panel discussion was moderated by Tara Shewchuk, vice president of ethics and compliance for Medtronic Spinal. Panelists included James Lynch, MD, neurosurgeon with Spine Nevada in Reno, Nick Shamie, MD, spine surgeon with UCLA Spine Surgery, and Hythem Shadid, MD, orthopedic surgeon with Genesis Orthopaedics and Sports Medicine in St. Charles, Ill.
Ms. Shewchuck began the discussion with an overview of CMS' Open Payments program, more colloquially known as the Sunshine Act. The act applies to manufacturers (all pharmaceutical, biologic and device companies) and their exchanges of value to physicians (excluding residents) and teaching hospitals. Subject to reporting are direct payments, indirect payments or transfers, physicians' ownership and investment interests in a manufacturer, and payments made on behalf or at the request of a physician or teaching hospital.
Sixteen categories of payment are covered by the law, including consulting fees, meals, travel and gifts. Items that are not reportable include product samples and transfers of less than $10, but Ms. Shewchuck said this is a bit of a misnomer. "The aggregate total is still $100, so if the value equates to $100 over a reporting period, it is reportable," she said. For instance, if a physician accepts 30 $4 coffees over the course of a year from a vendor, that would be a reportable gift, as it would total $120 over the course of a reporting period. "From the manufacturing standpoint, we have to track every manufacturing value, no matter how little it is," said Ms. Shewchuck.
Dr. Lynch said he finds the intention of the Sunshine Act honorable. "The transparency is noble, and it's transparency for patients, so they can look at their doctor and make individual assessments. We get that. That's front and center," said Dr. Lynch. "But a secondary thing is the government is trying to wrestle some control into this, trying to [reign] physicians in a little bit."
Dr. Shamie said surgeons didn't want to be singled out when the report was released. However, when the reports came out and surgeons saw they were average, they were happy about that, which pushes surgeons to aim for average.
The Sunshine Act has signaled the new normal, in Dr. Shadid's opinion, and physicians need to begin thinking in different ways. "We all have different ideologies about the role of government in our lives, but I think we'll do better if we come off not complaining about it," he said. "If we're defensive, people assume the worst. We need to be thinking about how we tell our story about this. All of us need to be able to explain how we're connected in the industry."
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