The Physician Payment Sunshine Act
The federal Patient Protection and Affordable Care Act of 2010, generally known as health care reform, includes a provision called the Physician Payment Sunshine Act. Effective August 1, 2013, the Sunshine Act broadly requires that manufacturers and distributors of medical products record and subsequently report to the federal Centers for Medicare & Medicaid Services (CMS) activity where a “transfer of value” to a physician, dentist or teaching hospital occurs that is $10 or more, and even activity involving items less than $10 if the aggregate value reaches $100 annually. The law does not prohibit these transfers; it only requires that they are reported.
What must be reported? And what’s a transfer of value?
The Sunshine Act classifies “transfer of value” activity into sixteen possible categories, including meals, gifts, travel and lodging, education, and consulting fees, among others. In short, any transfers of value, whether in cash-equivalent or in kind, that are provided to physicians, dentists or teaching hospitals must be reported to CMS, which will then make public those “transfers of value.” Reportable activity includes transfers of value made directly or indirectly to a physician, dentist or teaching hospital, as well as transfers of value made on their behalf or for their benefit.
Who does the reporting?
Generally, all U.S. manufacturers and distributors of drugs devices, biologics, and medical supplies must report transfers of value annually.
When does the reporting begin?
Companies filing the reports must begin gathering data on August 1, 2013, for a period lasting through December 31, 2013. The data collected in that period must be filed with CMS by March 31, 2014. Subsequently, the reporting periods are annual, with reports due March 31 of the following year.
What does this mean for me?
As a covered physician, dentist, or teaching hospital, if you are the recipient of a transfer of value, your name will appear in our reports to CMS and, subsequently, on a public, searchable government-maintained website no later than September 2014. The information that we must collect includes:
- Date Transfer of Value Occurred
- Dollar Value
- Transfer of Value Description
- Product Associated with Interaction, If Any
- Doctor or Teaching Hospital Name
- Doctor Primary Practice or Teaching Hospital Address
- Doctor Practice Type and Specialty
- Payment or In-Kind Item
- Destination for Travel Items
- National Provider ID
- Doctor Resident State License Number
What are my options?
The decision to accept a transfer of value is entirely yours. If you choose not to accept any transfers of value, your name will not appear in the public database. If you do accept a transfer of value in an amount that triggers the reporting requirement, we are required by law to include in our reports the information itemized above. Either way, we believe the Sunshine Act should not deter us from building upon our valuable relationship with you and meeting your practice needs.
Can I review the data?
Yes. The Sunshine Law gives covered recipients the opportunity to review and correct the submitted data. And because Ortho Organizers ® believes our customers should have access to their information before we file our reports with CMS, we have partnered with a software company to develop a website that provides pre-filing access. The website is physpro.net.
If I have questions, who should I contact?
Your Ortho Organizers representative is prepared to discuss the Sunshine Act with you and your staff.
More Resources on the Sunshine Act:
U.S. Centers for Medicare & Medicaid Services
American Medical Association
American Dental Association