Experts' View

Impact of the Physician Payment Sunshine Act on Market Research

MedPanel has been a leading healthcare market research provider for the last 15 years, so it was no surprise that we got a lot of questions from clients and physicians alike when the Affordable Care Act passed, which implemented the Physician Payment Sunshine Act (see short explanation here). In fact, with over 400,000 experts in our medical community, we received many, many questions!

Our medical experts primarily wanted to understand how much of their activity with MedPanel would be disclosed, and for them we had an easy answer: “None, unless we tell you”. As a market research vendor, and not a manufacturer, we are under no obligation to report any payments we make to them for their participation in one of our market research projects. In fact, many clients view MedPanel as the best way to achieve the most objective research results, because the research we conduct with physicians and nurses is double blind. This double-blind method also protects our clients from any liability in reporting honoraria payments to CMS, and protects our expert physicians from scrutiny of their participation. That said, certain manufacturers are giving up the double-blinded nature of recruiting through a vendor like MedPanel to protect themselves against future legal obligations by asking for the names and contact information for all participants to report those payments to CMS. In those cases, MedPanel informs respondents of the potential reporting during recruitment so there are no surprises.

The leading question from our clients was, “Will the new regulations lead to a decline in the number of physicians willing to participate in our activities, including market research?” That was a harder question for us to answer – most of our expert physicians, nurses, and hospital executives were nervous of public reaction when the data first became available in September, 2014. Many told us they would adopt a “wait and see” attitude to gauge public reaction before deciding their future levels of participation. Now that four months have passed, we wanted to reach out to our community of physicians in particular to measure their current awareness of CMS’s new disclosure platform (Open Payments), and to assess the impact the release of this data was having on their participation in outside activities.

From November 24th to December 15th, we invited our expert physicians to participate in a survey about the Sunshine Act and the Open Payments website. Though they received no honoraria for doing so, 461 physicians across diverse specialties contributed their perspective, which is detailed below.
 
Awareness of Physician Payment Sunshine Act
Despite the numerous media stories on the subject, as well as proactive communications (and custom-designed tools and apps) from the AMA, CMS, and others beginning back in 2013, only 37% of surveyed physicians felt that they completely understood the impact the new regulations. Almost two-thirds of physicians felt under-informed, with 16% indicating that they were not at all familiar with the law. We anticipate that this number will decline over time, especially as more information about physician payments is reported and analyzed through these new rules.
 
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Awareness of Open Payments Website
Under the new Act, manufacturer payments to physicians are reported to CMS quarterly, and are then posted to a public website called Open Payments. Fewer physicians were aware of the Open Payments website than were aware of the Physician Payment Sunshine Act (72% versus 84%, respectively), with almost one third (28%) of physicians having no awareness of the website, which first posted data on physician payments on September 30, 2014.

The primary source of Open Payments awareness for surveyed physicians was from news sources (media or professional societies), while a small portion of our expert community were made aware by a colleague.

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In what we believe will be a growing trend, 16% of our physicians said they were made aware of Open Payments by their corporate compliance officer. Private practices are increasingly being consolidated into larger healthcare networks to find economies of scale, resulting in more and more physicians becoming employees and subject to the regulation and scrutiny of corporate compliance officers. We expect that these compliance officers will increasingly educate their employees about Open Payments, and that some smaller percentage will actively monitor the reported data, resulting in more physicians becoming aware of the website through this channel in the future.
 
Behavioral Drivers of Open Payments Viewing
For those physicians who had visited the Open Payments website since launch, curiosity about what was reported about themselves, and checking for inaccurate reports were the two major drivers.

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Conversely, for those physicians who had not visited the website, 53% said that they had not visited because they didn’t care what had been reported, while 18% said they were sure nothing had been reported about them. Nearly half of physicians, though, said they had not visited simply because they had not found the time to do so.

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We anticipate that awareness and usage of the Open Payments website will increase as these 42% of physicians do find time to check their data going forward. Likewise, as employers, patients, and peers become aware of the data, those physicians who currently don’t care what is reported may start to care as their payments are scrutinized by other parties.

Accuracy of Payment Data on Open Payments Platform
Of the surveyed physicians who visited the Open Payments website, roughly half found inaccuracies in the reported data. 30% of physicians found that earnings had been reported by manufacturers that the physicians had not been aware of. Additionally, 14% of physicians said that payments they know they received were not reported in the system. Because manufacturers are liable for underreporting, this lack of disclosed payments should be concerning to manufacturers as it indicates their tracking and reporting processes are not robust enough.

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Impact of Payment Disclosures on Market Research Participation
As one would expect, passage of the Physician Payment Sunshine Act did not drive an increase in paid market research or consulting participation, with only 3% of surveyed physicians indicating such a trend. The large majority of our expert physicians say that their participation has remained stable since passage of the Act, but 21% of physicians say that their participation has decreased. As seen in the previous figure, 5-9% of our physicians were driven to check the Open Payments website because of concerns about what their patients, employers, or peers might see there. This concern about the propriety of receiving payments from manufacturers is likely a contributing factor to these physicians’ lower level of participation.

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As more physicians and more employers become aware of, and begin to analyze, the Open Payments data, will this level of concern increase and lead to an even larger number of physicians decreasing their participation in paid research or consulting? Or will expanding familiarity with the Act and the reported data lead to acceptance and even fatigue, and will concern plateau or even decrease, leading to once again expanded participation?
 
Conclusion
Opinions on whether the Sunshine Act serves the right purpose are varied. Some believe it will force doctors to adhere to an increased standard of ethics, while others believe it will impede progress in medical research by hindering the relationship between the medical experts and manufacturers. How this data’s role will play out in the years to come is hard to say. Will it create transparency or more sophisticated marketing loopholes?

As the healthcare industry adapts to the Physician Payment Sunshine Act, MedPanel continues to work with our expert community and our clients to help them understand and work within these new regulations. We are continuing to engage with community members on how best to use technology to help them track, compare, and disclose the payments that are made to them. And for our clients, the ability to work through us on double-blind projects protects them from the liability of reporting payments through Open Payments.
 
Questions or comments? Ideas for topics for our community to comment on? Contact us here