Do Patients Care About Your Sunshine Act Payments?

Disclosures

November 04, 2014

Who's Looking at Your Payments From Industry?

The initial anger over the Centers for Medicare & Medicaid Services (CMS) Open Payments program (aka the Sunshine Act) is starting to become somewhat quieter. But the current appearance of calm is not synonymous with acceptance, and for many, resentment and ire simmer right below the surface. As attention to the public data ramps up, physicians' reactions to the Sunshine Act have ranged from consternation to indignation to a dismissive "who cares?"

The first week of the data going public saw a flurry of doctor-payment lookups (despite problems with the site) by patients, news media, professional organizations, and some physicians checking out colleagues and acquaintances.

The public data will make a small percentage of doctors squirm uncomfortably and could even land some in hot water with colleagues or their institutions. For most, that won't be the situation. But physicians are still nervous about public reaction to data about a situation that patients probably don't fully understand. And there's no shortage of doctor-bashers who gleefully point to what they imagine to be collusion between physicians and industry.

Some patients will check out their physician's data out of sheer curiosity. Many patients would like to know more about their physician on a personal level. A number might note interestedly, "Look how much he received for entertainment and education!" although they don't particularly care one way or another.

But then what? Do patients note the data and then forget it? Are patients asking their doctors about anything they think is questionable?

It appears that—at least as far as patients are concerned—the hoopla over Open Payments was nearly as big a fizzle as was the supposed impending doom of Y2K. When I asked physicians what they heard from patients about their Sunshine Act payments, most responded, "I haven't heard a peep."

A Sandwich From a Drug Rep? Yawn.

In most situations, that's understandable. Amounts showing up like "$14.95" for food and beverage, or $75 for entertainment, are unlikely to raise distress signals among patients or anyone else. An inexpensive lunch from industry won't make people see red.

On the other hand, some data will probably raise eyebrows. Doctors with an ownership interest in a medical company who sold or prescribed that product without disclosing the relationship to patients may face some scrutiny and resentment. Doctors with large entertainment payments will have some explaining to do.

For most physicians who are not gaming the system, a major fear revolves around the misimpressions that patients could get without understanding the context.

Even CMS says on its site, "We encourage patients to discuss these relationships with their health care providers." And the American Medical Association (AMA) has developed Talking Points to help physicians with any discussions you may have with the public.

Most patients won't confront their doctors even if they have questions. If patients bring it up at all, they're more likely to say something neutral like, "Doc, what do you think of that new program where they post online everything a doctor has received from a pharmaceutical or device manufacturer?"

The AMA recommends some excellent answers, including, "What I can tell you is that I have never knowingly allowed support from industry to influence the recommendations I make for my patients." Doctors may want to say that interactions with industry can benefit patients and that the payment data to be posted may be inaccurate.

Internist Robert Juhasz, DO, president of the American Osteopathic Association, says that he is quick to remind the public that receiving a research grant or a lunchtime pizza is not necessarily a badge of dishonor. After all, collaboration between medicine and industry has yielded life-saving drugs and procedures. "We don't want to lose that," he said. Many physicians expressed their irritation and viewpoints.

The fact that patients aren't storming the streets about Open Payments data doesn't mean that the data disclosures won't bring negative professional repercussions for physicians. And it has certainly placed a damper on anyone accepting anything—including legitimate payments—from companies. It doesn't remove the sense that some doctors have, that eager people are rubbing their hands together, drooling with anticipation at being able to find fault with more physicians—whether or not it's warranted.

Have you had experiences with patients, family, or colleagues asking you about data in the Open Payments portal? Have you cut down on industry activities? What advice would you give to other physicians? Voice your opinion in the comments section.

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