Decoding The Sunshine Act: What Exactly are Manufacturers Reporting and How Does It Affect My Practice  

Presented by: Vanessa Towning

•  Defining the Sunshine Act as it relates to my practice •  Transfers of Value: What are manufacturers reporting about

my physicians? •  Should I change how the office interacts with reps? •  Does my practice need to do anything to be compliant? •  Keeping track of payments •  Q&A

Agenda

Defining The Sunshine Act  

The Sunshine Act Defined  •  The Physician Payments Sunshine Act (part of the Affordable Care

Act), requires manufacturers to report payments and "transfers of value" made directly to physicians and teaching hospitals

•  Describes how the recipient received the payment

o  (cash or cash equivalent, in-kind items or services, or stock, stock options, or any other ownership interest, dividend, profit, or other return on investment)

•  Manufacturers must specify the nature of the payment or transfer of

value that is made indirectly to a physician or that is made to a third party as requested by a physician or designated as being made on behalf of the physician

 

The Sunshine Act Simply Put  

The goal of the Sunshine Act is to bring transparency to the financial relationship between medical vendors and physicians •  Manufacturers report any applicable “transfers of value” to

physicians during non-educational interactions: •  Nature of the payment •  Recipient •  Value •  Product

There are exclusions  

Lunch and Learns: •  When a rep brings a meal as part of lunchtime educational

session, the total cost will be divided by the total number of people (physicians and staff) who partake in the lunch

•  $9.99 is the magic number

Gifts: •  Generally treated the same way as lunch and learns unless the

gift is directed exclusively to a non-prescribing staff member •  Charitable Gifts - if the physician directs the manufacturer to

donate the payment to charity, the manufacturer will report the payment in the name of the physician, and the charitable entity which received the payment

 

The Sunshine Act Transfer of Value

•  Conferences, CME, Food and Beverage

o  Speaking at a continuing education program

o  Buffet meals, snacks and soft drinks at conferences and CME events

o  Incidental items under $10 at conferences open to the public (pens, notepads etc.)

•  Existing personal relationships

•  Payments less than $10 (up to $100 for the year)

•  Educational materials that directly benefit the patient o  Diagrams, anatomical models etc.

•  Product and drug samples

•  In-kind items for the provision of charity care  

The Sunshine Act Exclusions

•  The reporting burden falls on the manufacturer

•  Make sure you are in the know! ü  Register with CMS to receive notifications about what information is being

reported

ü  Keep track of what payments or transfers you receive that must be reported

ü  Consider preparing explanations for these payments to communicate to patients who inquire

ü  Have open communication with your reps to avoid confusion and reporting discrepancies

ü  Review the data after it is submitted to CMS

ü  You have 45 days to dispute reported data and to request corrections

 

The Sunshine Act What Does My Pract ice Need To Do?

Should We Still See Reps?

 

Education •  Providers that see pharmaceutical reps are 4x faster to respond to

information available on new or existing treatments than those physicians that employ a “no-see” policy

•  Reps can provide insightful demonstrations/tutorials on their services that your staff may not be able to get from self education (handbooks, online forums etc.)

Samples

•  Online requests and applications vs. instant requests from a nearby rep

Services •  PAP information •  Market information

 

The Sunshine Act Does NOT Discourage Rep-Provider Interaction  

Have an open conversation with your reps •  Voice your questions/concerns

•  Vendors likely have plans in place to minimize your exposure while still providing you with the services your practice desires

•  You have control. Set the rules of the road  

Should I change current rep policies? •  Take a look at the your current policy in place. Does it:

ü  Preserve patient care?

ü  Give each rep an opportunity? (avoid manufacturer bias)

ü  Keep providers and staff informed and up to date on important issues facing conditions and treatment options?

 

What about the List  

Free Tools and Apps To Help Your Office Stay on Track

 

www.rxvantage.com

RxVantage x

Created by CMS •  Must manually upload all vendor data

•  Must understand payment terminology

•  Reads QR codes

•  Does not communicate with CMS

o  Will not validate any data provided

•  You can export data to a CSV file  

 

Open Payments App

RxVantage is a free web application for medical practices. Our simple to use solution saves your practice 15 hours a month of staff time typically dedicated to managing and tracking rep interactions.

What is RxVantage?

Benefits  

Free for Medical Practices - Free Version for Reps

Find the right rep fast

Eliminate rep scheduling hassles

Track Office exposure to the Sunshine Act

Help patients save 80% on their prescriptions

Sunshine Act Tracker

Automa(cally  populates  rep    informa(on  and  past  interac(ons  

•  The Sunshine Act brings financial transparency to the rep-physician relationship.

•  It does not prohibit physicians from interacting with reps

ü  There are several provisions that enable practices to continue to benefit from the services they receive from the rep community

ü  $9.99/person is the reporting threshold for lunch and learns

•  RxVantage provides a free service to help you stay in control of your

rep interactions and helps you navigate Sunshine Act reporting with minimal effort

Summary

Vanessa Towning Director of Marketing

Contact Info

Email vanessa@rxvantage.com Phone (310) 853 1977