UPFRONT

Misplaced Emphasis

Peter K. Kaiser, MD

One of the wonderful new aspects of the Patient Protection and Affordable Care Act (aka ObamaCare) will be enacted over the next few months: The Sunshine Act. In this well thought out piece of legislation, anything more than $10 (including meals and travel costs) that physicians received from manufacturers of drugs, devices, biological, and medical supplies must be recorded and listed on a publicly available Web site. This will continue annually.

We have the opportunity to see the data prior to the public unveiling but little if any recourse if the data are incorrect. If you haven’t already done this, you should register with CMS for the Open Payments System. The results will “surprise” you.

How to enact this legislation is so clear that all the companies affected know exactly what to report to CMS. Well, not really. Every company I have spoken with will report different things. Some will report any clinical trial payments (which can be in the millions); others won’t. Some will report CME events attended; others will not. Some physicians have companies pay their institutions, which then “launder” the money back to the physician in the form of salary or bonus. Should this be reported?

So the data, much like the ridiculous CMS physician payments Web site, will only serve to create sensational headlines, malign physicians, and do nothing for patient care. The numbers will likely be far from the truth.

The big question is what the purpose of this disclosure is. Does Congress tell us who gives them money when they enact the laws that affect all of us? Do they list on the Congressional Web site how much the Pharmaceutical or Insurance lobbies wined and dined them to leave them out of the ACA? I am sure the payments to Congress from manufacturers of drugs, devices, biological, and medical supplies far outweigh the totals paid to all physicians … by a large margin.

Now, to be sure, there are physicians receiving ridiculous sums of money from companies to support Product A over Product B. But does the government really think we are so shallow as to choose Product A based on the physician talking about it and not our own research? Will disclosing this information change this practice? More importantly, should patients decide who their doctor should be or how they should be treated based on this information?

And why stop at conflicts of interest? To me, the following questions are considerably more important to have listed on a Web site before someone should operate on me: How did you sleep last night? Did you work out the night before? Do you take any drugs or smoke anything (especially if I was getting operated on in Colorado)? Did you fight with your spouse this morning? And how is your psychological status? These questions have considerably more bearing on how they will treat me than how many free meals they got from drug companies. Once again, our government has completely missed the boat on what is important in health care.

What does this have to do with this month’s issue? Nothing. It was just a rant.