Sunshine Act: Are Doctors Still Enjoying Free Lunches From Drug Reps?

Leigh Page

Disclosures

November 21, 2017

In This Article

What Will Happen to Reporting Under Trump?

Because the Open Payments site is part of the ACA, passed by Democrats, will the Trump administration and the Republican Congress try to scrap it? That concern practically disappeared in July, when Congress failed to repeal the ACA.

That said, Open Payments always had a relatively good chance of being spared from the GOP ax. The provision was the brainchild of Republican Senator Chuck Grassley of Iowa, and its purpose—to provide patients with a search tool to help choose physicians—fits well into Republican leaders' support of healthcare consumerism.

The website "brings transparency to a big part of the health care system for public benefit," Grassley wrote in a November 2016 release.[30] "Transparency brings accountability wherever it's applied."

The Trump administration did, however, propose to "streamline" the program, according to a draft executive order reported[31] in June. "Streamlining" might refer to a proposal to remove certain CME payments from reporting, which several medical societies are requesting. HHS Secretary Tom Price supported this proposal in legislation late last year, when he was a House member, but Grassley opposed it and it was removed from the bill.

The Open Payments website hasn't had a great track record so far. It has cost manufacturers billions of dollars to set up and operate, and the data are still fraught with inaccuracies, which are a challenge for doctors to fix. Meanwhile, Open Payments has become a useful tool for journalists, plaintiffs' attorneys, and federal investigators to dig up damaging information against doctors.

The information in Open Payments is supposed to benefit patients, but relatively few of them seem to look it up, and when they do, they are likely to misinterpret it. What's more, most patients don't seem to want to bring the information up with their physicians, and probably wouldn't leave their doctors if they refused to change.

"Tracking more than 3/4 of a million doctors to possibly detect a rare unethical doctor is a waste of public resources and the predictive-value positive of this exercise is virtually nil," wrote a physician who was commenting on the 2014 Medscape article.[13]

The Future of Transparency

Furthermore, the information can do more harm than good, according to Lisa Rosenbaum, MD, a national correspondent for the New England Journal of Medicine (NEJM). "Injecting transparency into a hostile climate virtually guarantees that fragments of information will be spun into insinuations of wrongdoing," she wrote in a NEJM article[32] about the website.

Dr Rosenbaum regretted that once-productive relationships between physicians and industry are being unraveled by "pharmascolds." But, she added, "Once we've shined a light, there's no turning it off."

Sullivan, another critic of the website, also believes it's here to stay. "I think overall that it's served its purpose," he says. "It's a catch net. You may not use it, but it's there."

Meanwhile, the movement against conflicts of interest seems more robust than the Open Payments website.

Ethicists and policy committees at large institutions have come out against spending on such items as meals and tchotchkes, which do not directly help patients and often don't contribute to physicians' knowledge.

Sullivan regrets that some useful services have fallen by the wayside, such as reprints of journal articles that drug representatives used to drop off at offices. Under the Open Payments reporting system, companies would have to account for each one. "It's kind of sad or ridiculous," he says.

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