Sunday, August 11, 2013

The Sunshine Act Exposes Physician Payments: New App Suggested

A few weeks back, a drug rep, aka a pharmaceutical representative, came to the office hawking a new constipation medicine.  These guys are in a tough racket.  They need to sell products that we physicians are often unable to prescribe.  It’s the Formulary, Stupid.

The Best Disinfectant

In the olden days, before I entered the hallowed halls of healing, pharm reps, or drug detailers, developed relationships with physicians who would then prescribe their drugs.  Physicians to this day deny the incontrovertible truth that we are influenced by pharmaceutical company marketing techniques, which still feature face time between sales folks and prescribing physicians. 

These days, many of the sales tools used years ago have been properly prohibited.  Physicians cannot be flown to exotic locales and paid big bucks so they can serve as ‘expert consultants’ who will be subjected to push polling on the new pharmaceutical product.  (Why didn’t any company ever ask me to serve as an ‘expert’?)

As is often the case, the new laws that are designed to promote ethical behavior and restrain corruption have become OperationOVERBOARD.   The Sunshine Act, a part of our beloved Obama Care Affordable Care Act (ACA), is now fully operational.  Pharmaceutical companies are now required to report to the Federal Government if a physician receives an individual item valued at $10 or more, or accrues an annual total of more than $100.  These ‘transfers of value’ will be posted for public viewing. 

We physicians do not want to be on the government’s Sunshine Act Wall of Shame, which conveys that we are evil and corrupt practitioners.  Will the public really be able to distinguish a tainted doctor who has taken possession of a $12.99 tote bag from another rogue who has  acquired a $14.95 breakfast tray for the staff?  Did the ACA consider that these dilemmas will vex and torture patients who may miss their doctors’ appointments as they will be spending so much time scrolling through the roles of tarnished physicians?  This will directly and negatively impact on their health.  The ACA should have had their IT folks incorporate a time limit on Sunshine Act website viewing.  This is an individual mandate that I could enthusiastically support.

Here’s how I intend to remain just under the government’s radar, although we are now learning that government surveillance is slightly more intrusive than it has admitted.

Consider these contraband items:

Tuna sub                             $5.99
Tuna sub with cheese     $7.49
Medium size beverage   $1.69
Large size beverage        $2.19
Chips                                     $.89
French fries                       $2.49       
Cheese fries                       $2.99
Cookies                                $.99

I will assume that the $10 total includes sales tax, but I will have to consult my accountant and attorney to verify this.  Obviously, if tax is excluded then I will have more funds available and would probably be able to add a peppermint patty to my food order while remaining comfortably under the mandated threshold. 
Although I enjoy cheese, and I am fortunate not to suffer the dreaded disease of lactose intolerance, I will order a cheeseless tuna sub so that I will have greater ordering flexibility.  I now have $4.00 left to spend, leaving aside the critical tax issue referenced above.   Readers who are computationally advantaged have already determined that I cannot enjoy a large size beverage along with cheeseless French fries.  Even a medium size beverage will put me over the limit.  I could order any beverage size with either chips or cookies.  I don’t really like these two items, but if eating vitamin fortified potato chips and omega-3 laced cookies will keep me off the list, then I will do the right thing.

I suggest that an entrepreneurial whiz kid design an App that can instantly provide physicians with all permutations of menu choices from area restaurants that will not cross the Sunshine Act’s $10 limit.   Hurry before Yelp administrators, who are avid Whistleblower readers, incorporate this feature into their App.

Does anyone out there think that our government needs a little sunlight shining on it?




8 comments:

Anonymous said...

Michael,

I understand your frustration at government regulation . . . a bit overboard. But where DO you draw the line? If not $10 . . . then $20; if not $20 . . . then $30. And WHO put you in this position. (Hint: A bunch of greedy physicians and corrupt pharmaceutical employees.) I rail against so many things that are wrong with our 'government' . . . but when I look in the mirror, I see that ignorance, unawareness, "it doesn't affect me" attitude, and a naive trust in elected officials place me in the 'who's guilty' column, too.

If some physicians had not abused their position to enrich themselves (for quite a long time) . . . there would have been no revelatory investigative reporting, and no need to over-react with such nit-pickery that paints all physicians with the broad brush of privilege and greed.

Melody

(P.S. As a child [long ago] my Mom would give me a quarter to go to the movies. A ticket cost 10 cents. With the remaining 15 cents, I could buy popcorn (10 cents) or a soda (10 cents) and a candy bar (5 cents). Choices! Choices! I always felt cheated that I could never have popcorn AND a soda.]

Michael Kirsch, M.D. said...

Melody, good to hear from you. Hmmm, ten cent popcorn? That gives me an idea of your station in life. The first president you vote for was...?

I don't know precisely where to draw the line, but it should be higher than the present one. My piece dealt only with pharmaceutical payments. The medical profession is riddled with scores of idiotic regulations and mandates that help no human being except those employed to enforce these ridiculous regs.

Anonymous said...

Agree entirely . . .a good example is our regulatory FDA--in charge of adverse event reporting. Sometimes I blame the medical profession; but when I recognize that the system, itself, is intentionally cumbersome and inefficient, it's difficult to place the blame on M.D.'s who, if they report, are trapped in a web of ongoing follow-ups . . . and for what? Preventing (future) patient harm--doubtful.

When I discussed this with my best friend, he pointed out that YOU (doctors) are now trapped by regulation, while BigPharma voluntarily reports large payments to an on-line data base. Guess you'll have to get creative; have the gift-giver eat hearty (cheese, fries, large drink), you stick to the austerity order--then switch plates!

First president . . . either Nixon or Humphrey. I was apolitical back then, probably checked the box for whichever was most photogenic (ha!). One thing age does is help one forget some of our youthful errors.

Melody

Michael Kirsch, M.D. said...

@Anonymous, aka Melody,are you an Obamacare supporter which would be a non-youthful error?

Anonymous said...

Michael--

I believe basic healthcare is a human right. No one should be allowed to die because they don't have insurance or money. As for Obamacare--a RubeGoldberg "fix" that fixed very little--I saw real potential in its embryonic talking points; then insurance companies, pharma & device manufacturers, medical associations et al. (and their paid-for shills in Congress) grabbed hold of the pen and wrote this mess now labeled "Obamacare". Personally, I would like a Medicare-for-all, with provisions for a regulated insurance industry that, for a price, would provide extraordinary coverage for those who want and are willing to pay for exceptional privileges.

Back in my days of bliss (ignorance), I was proud to extend an index finger into the air and chant "We're number one." Now that statistics belie that fact in ever so many areas, it is not my index finger that I imagine extending, to those who nominally "lead" us.

Melody
(used-to-be-a-Republican, then used-to-be-a-Democrat, now ashamed of our two-party "democracy")

Michael Kirsch, M.D. said...

Health care a right?
We should provide someone with coverage who misses doctor appointments, smokes, rides a motorcycle without a helmet and won't take his medications? Where the responsibility factor here? If we provide insurance coverage for such an individual, would this infringe on society's rights?

Anonymous said...

Michael--

We're looking at the same glass; whether it's half full or half empty is a viewpoint. You want to talk about responsibility (or lack thereof); I want to talk about low-income, jobless, homeless individuals who get sick. Despite what George W. Bush said (they can all get treatment at an emergency room), that is not always true. More importantly, that often is not the appropriate venue (emergency care) for many health needs.

While we can agree or disagree, I think the political divide has made the issues more controversial than they should be. Do I think you should provide free colonoscopies for all? No. Do I think you ought to provide pro bono care for some? Not really. Medical care should not depend on individual conscience or charity. Do I think someone who has a bloody discharge, or unexplained fatigue/anemia--not immediately life-threatening--should be able to obtain a colonoscopy and treatment even if he/she is poor or uninsured? Yes.

Somehow, I can't believe that we can't get some really smart people in a room--people without a profit-motive guiding every decision--and solve our problems. When we throw in 'R' vs 'D', free-marketers vs socialists, the opportunity for problem-solving seems to evaporate.

I appreciate your concern about personal responsibility; hopefully you can appreciate mine about caring for our most vulnerable.

Melody

(P.S.: I get it that missed appointments are a sore point for you. I have a small business of my own--and experience the same frustration. But think about the other side of the problem. When I leave home in order to provide a margin of error, arrive 10, 15, 20 minutes early (my bad) only to have a doctor running behind by half an hour, I also experience frustration (and anxiety). The ultimate dimissal though, is a usual lack of apology or explanation. Every situation DOES have two sides.)

Anonymous said...

Michael--

Sorry for piling on, but the comments (3 of them) are illustrative of the dissatisfaction of today's healthcare system (Obamacare or pre-Obamacare). I recognize there are more 'complaints' than 'solutions' . . . but I think a lot of people are beginning to wake up to our national dilemma.

Melody

http://1boringoldman.com/index.php/2013/08/15/right-about-that/#comments

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