The Sunshine Act, which is also referred to as Open Payments, affects most medical practices. The overarching goal is to shed light on the relationship between industry (pharmaceutical companies and other medical vendors) and the individual medical practices.
The educational interactions between your practice and the professional representatives that call on you are invaluable, and certainly the information you receive ultimately results in better patient care. One of the most practical first steps in navigating the Sunshine Act is to implement a rules-based system that manages how your practice interacts with representatives, and to also keep track of these interactions. At its core, that is what RxVantage does.
More specifically, one of the most valuable tools of the RxVantage platform is the Sunshine Act Tracker. It enables medical practices to capture and report on data for recording exposure to Sunshine Act thresholds. For example, the Tracker will capture, record and track the dollar value of meals served during pharmaceutical presentations. With the data organized by the RxVantage platform, medical offices have a comparison set against what is reported to CMS by manufacturers, which amounts to a verifiable record of actual interactions.
In less than 30 seconds the practice manager can record all transfers of value associated with an appointment booked through RxVantage. In one common example, when a modest meal is served during an educational presentation to the doctors and staff, with a few clicks the practice manager can record the cost of the meal, the caterer, the office staff and providers who attended and contact info. The manufacturer name is already recorded in RxVantage, and this will be combined with the practice-entered data to create precise reports.
In addition, RxVantage provides medical offices with the capability to set customized rules for rep visitation. These rules are automatically enforced by the system. We invite you to learn more about RxVantage (clicking on this link is a good place to start). As well, we have provided a number of resources for you below to get more up to speed on the Sunshine Act.
Webinar Presentation: Decoding the Sunshine Act: How it Affects Your Office-Rep interactions
What is the Sunshine Act?
The Physician Payments Sunshine Act (sunshine Act) which is part of the Affordable Care Act (ACA), requires manufacturers to report payments and "transfers of value" made directly to physicians and teaching hospitals. Manufacturers are required to describe how the recipient received the payment such as 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. In addition, manufacturers must specify the nature of the payment or transfer of value that are made indirectly to a physician or that are made to a third party as requested by a physician or designated as being made on behalf of the physician.
- Ownership interests: manufacturers as well as GPOs are required to report on ownership interests held by physicians and their immediate family members. The transparency report must include the dollar amount invested, the value and the terms of ownership or investment interest, and any payment provided to a physician owner or investor. However, there are certain ownership interests, such as securities, which may be purchased on terms generally available to the public and which are listed on a stock exchange in which quotations are published on a daily basis, which are not reportable ownership interests.
How will sales reps be involved?
When representatives deliver items of value that must be reported, they will record the nature and value of the item(s), and the physician(s) to whom the items were transferred. They will also record the name of the related drug, device, biologic, or supply (i.e. the product that the rep was discussing).
How does this affect 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. For example, if a rep brings a $125 lunch for 3 physicians and 7 staff members, $12.50 ($125/10) will be reported for each physician. If the per person cost of the lunch is less that $10, it will not be reported (unless the total annual value of transfers to an individual physician exceeds $100).
Are patient samples reported as payments to physicians?
No. Samples, vouchers and coupons are not considered payments or transfer of value to physicians, nor are any educational materials that directly benefits patients or are intended for patient use.
Will low value payments be reported?
If the value of an individual payment or transfer is less than $10 per physician it will individual physician exceeds $100 per year, from an individual manufacturer, all transfers will be reported. For example, if a physician receives a single $5 journal reprint in a given year, it will not be reported, but if they receive 21 $5 journal reprints in a year (21x$5=$105), all 21 transfers will be reported.
How does RxVantage help medical practices with the Sunshine Act?
When a medical practice uses RxVantage to coordinate rep visits, in addition to saving time and avoiding headaches, they get a digital, detailed record of all rep visits. When the manufacturers submit their records for individual physicians to review each year, practices who use RxVantage will quickly and easily be able to cross-reference it with their RxVantage records.
In Q3 2013, RxVantage will be adding additional functionality that will allow practices to track exactly who attended a given appointment, as well as the total cost of the associated meal (if one occurred). Via RxVantage, practices will have the option to gather the same data from their rep that the reps report to their company.
Other Sunshine Act Resources
Webinar: The Sunshine Act: Best Practices From Your Peers
Click here to view.