Sunshine Act: The Intersection of Federal Law, Physicians, and Corporate Attorneys

Seth Bilazarian, MD

Disclosures

March 24, 2014

In This Article

Are You In or Out?

Where do you want to be on the Sunshine Act list? Do you not want to be on it at all? Does this represent some kind of ethical purity, or does it represent an issue that you don't really attend any kind of educational gatherings or educational forums sponsored by industry? Is that a good thing, or is that not a good thing?

If you attend educational meetings in your community as frequently as once a month, you can have at least $1000 from multiple vendors. Is that acceptable? Is there going to be so much noise on these reports that a small amount of variety of these listings is sort of an expectation?

How about larger values? One of the concerns has been that if you participate in research and your organization, your practice, or your institution receives hundreds of thousands of dollars in research, then it will be listed potentially under your name, implying that you are the recipient of this large quantity of money.

Does the listing of another physician, as I mentioned, affect your willingness to refer to that physician? If a physician receives most of his financial support from, say, a single manufacturer or a single cardiology device manufacturer, does that have an impact on your referral?

And then the last question I think is unclear, but it is concerning: From a public standpoint, is this listing equivalent to a conflict of interest? I think this is a significant issue. What if you have a drug or a device that you believe in wholeheartedly, and you think it is underused and you would like to promote its use just because you think it is valuable for other physicians to know about it and for our patients to use it. I might use the new/novel oral anticoauglants (NOACs) as an example. Does it automatically taint your support of them because you are sponsored for speaking on them? These are very complex issues that are not yet sorted out.

When the ACA was in the process of being passed, Speaker Pelosi said that we have to pass the bill so that you can find out what's in it. I thought that that was an apocryphal conservative conspiracy, that phrase, but actually it is true. It is there on the YouTube video for you to watch, if you want to find out what is in the Sunshine Act as it gets rolled out.

There are some alleged safeguards -- and I use the word "alleged" -- that might help prevent us from being inaccurately represented on these reports.[5] We are going to be using the National Provider Identifier (NPI) number for most things. I have had to use it several times, registering for the American College of Cardiology (ACC) and registering for some pre-ACC meetings sponsored by other people. The NPI is now being used to prevent any kind of mix-up between physician names.

One of the concerns that I have is that I work in several community hospitals, and I am asked to fill out a conflict of interest report annually. I do so as thoughtfully and fully as I possibly can -- but it asks me to go back and report updates throughout the year, and I really don't know what that means. Does that mean if I go to a dinner meeting and have $120 ascribed to me as a value, I need to go back and report to all the hospitals that I have this value? It is a concern that when these different databases are compared, will it appear that I omitted something of significance?

We can ask industry representatives about this, and I have been trying to ask what their handling of certain things of value are and how that will be ascribed to me.

Generally, what is reported will be anything greater than a $10 value. I think it is very simple to try to remember that. That is an important sort of thing -- anything over $10.

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