Wednesday, August 8, 2012

Wonder Wednesday: Sunshine Act

What do third party meeting planners and hotels need to do to prepare for the impact of the Sunshine Act (page 571)?

The Sunshine Act has third-party planners and hotels scrambling to get ready for the first of many impacts from the Sunshine Act. The goal of the legislation is to provide all record of all payments and “transfers of value” made to physicians and other covered entities to the Centers for Medicare and Medicaid Services (CMS). The CMS will post the payments on a website where the physicians will have 45 days to review, comment, and contest any payments or “transfers of value”. After 45 days the transactions will be posted on the website for the public to be able to review. The objective is for patients to see the payments or “transfers of value” being made to their physician and decide if there are any conflicts. Payments are supposed to be standardized and consistent.
There are many articles and comments on the randomness of applying large payments to physicians conducting clinical trials, Continuing Medical Education and meals that they did not even attend.  At Meeting Sites Pro our concern is how do we report the payments and “transfers of value” that occur at your typical clinical trial or advisory board meeting.  Honoraria, plane tickets and hotel rooms are pretty straight forward.  The dollar amount on the bill/check is put in the physicians’ account using the Individual or Organizational NPI number.  The hard questions for us are how do we report and assign values for all the other costs of the meeting?  Generally speaking we have asked our clients and they tell us how they have decided to treat various expenses for their entire organization.  The problem is that each client has slightly different methods to assign “transfers of value”.  Below are several different examples of how assigning “transfers of value” can be difficult for us.
Example 1 - If a physician is picked up at the airport by a sedan and the cost is $75  than the physician is credited with a “transfer of value” of $75.  That is pretty straightforward.  If three physicians get in the sedan should they each receive $25 of value or should they each receive $75 of value.  Right now clients are collecting data using both methods and allocating values that vary significantly (300%).  Another question for this example is what is the “value” that should be allocated on a transfer from the airport to the hotel?  Should the “value” be the cost of the Sedan, the cost of a taxi or maybe even the cost of a shuttle?
Example 2 - A dinner meeting at a hotel with 30 guaranteed physicians at a cost of $50 per physician for a total guaranteed cost of $1,500.  If only 15 physicians attend should the physicians be allocated $50 (the expected ”value”), $100 (the total spend) and should the physicians who did not attend be allocated their $50 of expected “value”.  How do you think the physician who attended the meeting is going to react when he sees a $50 value or a $100 value on his website report?  What about the physician who did not attend being allocated $50 of “value” for a meal he was not at?  When the physician contests the allocations how much time is it going to cost the company to research the charges, how they were allocated and respond?
Example 3 - A meeting with 10 external physicians and 10 internal personnel has a management fee of $1,000, a room rental of $1,000 and AV equipment costs of $1,000.  Should these “values” be allocated to the physicians at all?  If you answered yes, what is the correct allocation of value?  Should clients allocate “value” to only the physicians ($300 per physician), to all attendees ($150 per attendee), or some allocation in between the two choices?  Remember the objective is for all reports to be standardized and consistent. 
Right now CMS is still reviewing the 329 comments they have received from Physicians, Physicians families, Hospitals, CME Providers Medical Device and Pharmaceutical companies.  Hopefully when they finalize the regulations they will give us some additional guidelines to help our clients provide standardized and consistent reports for the public.  Until then our clients and their attorneys will have to continue using their best judgment on how they should properly allocate transfers of values to physicians and covered entities.

For more information on the Sunshine Act please visit the resources below:

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