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”, also known as “Open Payments”, 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 physicians, advanced practice providers, and teaching hospitals (referred to as “Covered Recipients”). The law does not prohibit these transfers; it only requires that they are reported. Transfers of Value “(Payments”) from Henry Schein Affiliates will either be consolidated with Henry Schein payments or reported independently by the affiliate company. Henry Schein is committed to full transparency and accuracy of all reported transfers of value.
Who is considered a reportable “Covered Recipient”?
“Covered Recipients” are any physicians, advanced practice providers, or teaching hospitals during the last calendar year for which such information is available. This includes dentists, doctors of medicine or osteopathic medicine, podiatrists, optometrists, chiropractors. Open Payments expanded in January 2021 to include five new provider types: physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists & anesthesiologist assistants, and certified nurse midwives. Medical and Advanced practice residents are excluded.
What must be reported? And what’s a transfer of value?
The Sunshine Act classifies “transfer of value” activity into various 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 a covered recipient 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 covered recipient, 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?
The reporting periods are annual, with reports due March 31 for the preceding calendar year.
What does this mean for me?
As a covered recipient, 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. The information that we must collect includes, but not limited to:
- Date Transfer of Value Occurred
- Dollar Value
- Transfer of Value Description
- Product Associated with Interaction, if any
- Doctor or Teaching Hospital Name
- Healthcare Provider Primary Practice or Teaching Hospital Address
- Healthcare Provider Practice Type and Specialty
- Form of Payment (cash, in-kind items or services, ownership interest)
- Destination for Travel Items
- National Provider ID
- Healthcare Provider 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.
How can I view what has reported?
All reported transfers of value data can be viewed at https://openpaymentsdata.cms.gov/. Transfers of value can be viewed by Company, Teaching Hospital, or Healthcare Provider.
If I have questions, who should I contact?
Inquires can be sent to [email protected] or if you have any questions pertaining to the Sunshine Act (Open Payments) program, submit an email to the Help Desk at [email protected]. For live assistance, call Open Payments Help Desk Support on 1-855-326-8366 (TTY Line: 1-844-649-2766). The Help Desk is open Monday through Friday, from 9:00 a.m. to 5:00 p.m. (ET), excluding Federal holidays.