Excerpt from "Bringing Transparency to Medicine: Exploring Physicians' Views and Experiences of the Sunshine Act," posted on The American Journal of Bioethics Online, May 24, 2017.
Abstract:
The Physician Payments Sunshine Act (PPSA) requires health care product manufacturers to report to the federal government payments more than $10 to physicians. Bringing unprecedented transparency to medicine, PPSA holds great potential for enabling medical stakeholders to manage conflicts of interest (COI) and build patient trust—crucial responsibilities of medical professionalism. The authors conducted six focus groups with 42 physicians in Chicago, IL, San Francisco, CA, and Washington, DC, to explore attitudes and experiences around PPSA. Participants valued the concept of transparency but were wary of the law's design and consequences. They downplayed PPSA's potential and felt it undermined public trust. Showing broad unawareness of COI, they dismissed the notion of industry influence and welcomed company “perks.” Misapprehensions may leave physicians unprepared to advance the opportunities PPSA holds for professionalism. The authors offer recommendations for government and medicine to improve physicians' and other stakeholders' understandings and use of the data.
Between 2004 and 2010, U.S. Senator Charles Grassley (R-Iowa) spearheaded dozens of Congressional probes into the relationships between physicians and pharmaceutical and device companies. Grassley's cases highlighted prominent physicians whose industry ties were often unknown to their academic medical centers (AMCs). “The whole field [of medicine] is connected by a tangled web of drug company money,” Grassley contended: “[For] the sake of transparency and accountability, shouldn't the American public know who their doctor is taking money from?” (Grassley 2007, S10721-2).
Grassley was inspired by state and local laws requiring companies to publicly report their payments to health care providers. In such places as Vermont, Maine, Minnesota, Massachusetts, and the District of Columbia, AMCs, patients, journalists, and other members of the public have had access to crucial information about physicians' company ties (Ross et al. 2007; Chimonas, Rozario, and Rothman 2010; Kesselheim et al. 2013). Believing a national transparency law was needed to mitigate conflicts of interest (COIs) in physician–industry relationships, Grassley drafted the Physician Payments Sunshine Act (PPSA). It became law in 2010 as Section 6002 of the Patient Protection and Affordable Care Act, with surprisingly little debate or media attention. PPSA requires drug, device, and other commercial health care entities to report to the Center for Medicare and Medicaid Services (CMS) all payments over $10 to physicians and teaching hospitals (Patient Protection and Affordable Care Act 2010. CMS, in turn, makes the data public on a searchable website, Open Payments (Centers for Medicare & Medicaid Services 2014b).
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