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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