By Gary Palgon, VP Healthcare Solutions, Liaison Healthcare Informatics
One provision of the Patient Protection and Affordable Care Act is the Physician Payment Sunshine Act. This measure requires manufacturers of pharmaceuticals and medical devices covered by Medicare, Medicaid and the Children’s Health Insurance Program to report to the Centers for Medicare and Medicaid Services (CMS) payments of more than $10 made to physicians starting in 2013.
Although its purpose is to ensure transparency, the Sunshine Act isn’t all sunshine. According to a recent edition of PharmaVOICE, a survey of 110 American physicians and 223 global life-sciences executives indicates physicians have concerns about how the public will interpret the data. For example, the law covers clinical trials, royalty payments and loaned equipment, not just material gifts or trips. Even “try and buy” programs where a physician has medical equipment for more than 90 days must be reported. Many physicians, who might speak on behalf of numerous pharmaceutical companies, participate in advisory boards and conduct clinical research, are not even aware these new rules exist and might be shocked to find their names listed on a company’s website next to a dollar amount. As a result, physicians might be reluctant to participate in continuing education and clinical research trials.
Meanwhile, the life-science executives are concerned about aggregating and reporting the data. Reporting all the required information may prove problematic given the relevant information is spread out across organizations. Identifying and collecting the information could be problematic — data pertaining to one contract might be held by the legal, financial, and medical departments. And furthermore, in order to meet the requirements, there needs to be real-time or near-real-time tracking of spending and the spending needs to be granularly categorized.
SAP found this to be true as well when they noted in Engaging the Healthcare Practitioner, that a multibillion dollar life-sciences organization could have these types of transactions coming from as many as 20 different source systems. And like other business problems before it which has required large volumes of complex data aggregated from many sources, the most important part is that the data needs to be clean and the information complete about practitioners and transactions.
The stakes are high. Penalties for missing payments range from $1,000 to $100,000, up to $1,000,000 per company per year. As the deadline approaches, companies are increasing their spending on methods of compliance. One way for a company to meet these demands is to use cloud-based integration and data management solutions that can join disparate sources of data, ensuring that different interfaces and formats are harmonized in a scalable and flexible way. This model also enables organizations to move quickly without needing a large capital investment to comply with the regulations.
What are you doing about integrating and harmonizing data to comply with the Sunshine Act? Are you making sunshine out of the Sunshine Act?
Until next time,