Many Groups Show Their Concern
Concerns about the registration process led the Medical Group Management Association (MGMA) and 25 other organizations to send a letter to CMS that identified "certain pressing issues related to implementation" of the Sunshine Act. Foremost was a request for CMS to describe how they plan to provide the public with context for understanding the information that will soon be released. Congress had mandated CMS to provide such context, the letter noted, specifically to avoid potential public confusion and misinterpretation of the data.
The letter also asked for greater outreach and education to physicians about "what will be reported, when it will be reported, what the reporting will look like, and how they can see what will be reported about them." Finally, the letter urged CMS to try to simplify the registration process, which physicians have complained is cumbersome and overly personal and poses the risk of discouraging some from completing the registration.
How Much Do Patients Care About Public Payment Reports?
Seeing as the point of greater transparency is to ultimately educate the public, do physicians feel their patients could be affected by information about them in the new database? "A patient comes in and makes a judgment about the physician -- is he or she interested, caring, competent, engaged?" said Hood. "They're not going to say, 'How many CME talks have you given recommending the blood pressure med you just prescribed?' or 'Did you ever attend a meeting of the manufacturer?' Give me a break!" He added: "Maybe when the patient comes in who's been on the same outdated medication regimen for 24 years, he'll realize it would have been better if his doctor had gone to a CME meeting and received an update on current treatments."
But some patients clearly welcome transparency. Martin Greenberg, MD, Doris Greenberg's husband, is a neonatologist who became a medical ethicist several years ago and now serves as Professor of Bioethics and Professionalism for Mercer University School of Medicine in Savannah. He observed that an acquaintance facing orthopedic surgery was told by his surgeon, "In the interest of full disclosure, I must tell you that I helped develop the device I'm giving you, and I get royalties from its use." How did the patient react? "He said, 'It made me feel better about this doctor, whose reputation I knew was excellent. It was reassuring that he was so open with me." Of course, in this instance, the patient had the context that many are concerned will be lacking in the CMS's public release of data.
Devarajan, the resident physician, believes certain patients will be affected by this reporting: "They'll look at the data and draw their own conclusions." Some doctors fear that when patients are given such information out of context, they may get negative reviews, "and they can't defend themselves."
What's to Come?
CMS has requested comments on the proposed changes, and it specifically asks for feedback on two alternatives: expanding the list of accrediting organizations by name, or specifying standards for accreditation or certification that would permit the CME exclusion. Comments must be received by September 2, 2014. The ACCME, American Medical Association (AMA), AAFP, MGMA, CME Coalition, and many other groups are preparing to submit statements in opposition to the change.
Ethicist Martin Greenberg said, "There have been improprieties and excesses in the past, but the situation in CME now fairly well covers everything. The AMA guidelines are very well delineated." Describing the proposal to remove the CME exemption as "a tempest in a teapot," he added, "I'm a very liberal person, but this is just too much regulation."
Hood, the Lexington, Kentucky, internist, isn't optimistic that the effort to reverse the CME exemption will succeed. "I don't think there will be enough political heat to make CMS change their position."
Click here to let CMS know how you feel about the Sunshine Act CME exemption.
A decision is expected in November.
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Cite this: Sunshine Act Expands, Creates More Thorny Issues - Medscape - Aug 11, 2014.