Healthy Skepticism Library item: 13103

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Publication type: news

MedPAC Evaluating Concept of National Physician Gift Reporting Database
FDALegislativeWatch 2008 Mar 11
http://www.fdalegislativewatch.com/2008/03/medpac-evaluati.html#more

Full text:

The Medicare Payment Advisory Commission is examining options for overseeing gifts and other financial support physicians receive from the drug industry, including proposals to establish a national online reporting database.

The issue was discussed at a March 5 commission meeting, in the context of a broader MedPAC review of public reporting of physician relations with drug and device manufacturers, hospitals and ambulatory surgical centers.

The group has not reached any conclusions yet, as it intends to work until the fall in developing its position. However, commissioners aired a number of differing views and concerns, including beliefs that such gifts need to be further curbed, concerns about increased workloads for manufacturers or federal agencies, and questions about the effectiveness of state versus national guidelines or reporting requirements.

“I think reporting is really important … but the idea that we need some kind of federal standard, I have a lot of problems with [it],” said MedPAC member David Durenberger, University of St. Thomas. He suggested that “you’re going to get a lot more progress than if we ever decide we’ve got a national reporting standard and it’s all going to be $100 bucks.” Durenberger’s nearly 20-year tenure as a senator included several years chairing the Senate Finance Health Subcommittee.

Nicholas Wolter, a physician with Montana’s Billings Clinic, suggested that even “beginning to define the sort of breadth and depth of these relationships is important of itself, to say the least. I am a very big fan of doing the public reporting … from hospitals or from vendors because I think in the act of reporting some self reflection is involved.”

But taking a more cautious stance, Francis Crosson said, “I’m torn about whether the reporting is going to have significant influence.” The value “would depend upon the complexity and difficulty of doing it versus the likely impact.”

Crosson is with the Permanente Federation and noted that the Permanente medical plans have a policy against accepting gifts from industry.

He suggested that reporting standards or gift restrictions might be more practicable when set by a health care plan. “If we can move towards a health care system which is more organized in integrated delivery systems … we can begin to set internal guidelines, then a lot of this will ultimately disappear,” he said. “I think it will be difficult to consider enforcing this in a disaggregated health care like we have at the moment.”

Two pending legislative proposals call for a publicly available Internet site to record physician gifts from manufacturers.

Commenting last fall on one of those measures, the Physicians Payment Sunshine Act, S. 2029, the Pharmaceutical Researchers and Manufacturers of America said it would create a “bureaucratic nightmare,” which could require companies issuing medical education grants to fulfill extensive reporting requirements for numerous health care workers.

The House bill, H.R. 3023, includes some allowances to shield information considered trade secrets, unlike the Senate bill.

But MedPAC staff working on this subject for the commission expressed concern that providing a trade secret provision, as Vermont does, might lead to significant underreporting of payments.

The staff noted other drawbacks in or variations among pharmaceutical marketing laws in Maine, West Virginia, and D.C., as well as Vermont. These include that the states provide only an aggregate report on payments, not detailed by provider or manufacturer; data is not searchable; and definitions of payment types and purposes may be vague. The staff’s presentation was based on resources such as literature reviews.

Some commissioners said MedPAC also might want to look at direct-to-consumer advertising, as it can exert as much influence on patients and prescribers.

For example, “I would love to expand [restrictions] … with really stopping the direct communication [ads] to the patient,” said Ronald Castellanos, Southwest Florida Urologic Associates. “It’s disruptive to my practice … It’s not just this financial relationship, I think it’s advertising in general.