Buried deep within the massive health care overhaul passed by Congress are tough new laws that will soon shine a much-needed light on physicians' lucrative financial ties to industry. Known as the Physician Payments Sunshine provisions, these are some of the most significant, yet unheralded, reforms contained in the historic health care legislation signed by President Obama last month.
The Sunshine provisions, long championed by Iowa Republican Sen. Charles Grassley, deal with the myriad consulting arrangements, speaking fees, trips, dinners and other gifts -- dubbed "transfers of value" in industry jargon -- provided to doctors at clinics large and small across the nation. The reforms will require public disclosure of payments -- generally $10 or more -- from manufacturers of drugs, medical devices, biologics and medical supplies. These firms will also have to report similar payments made to teaching hospitals.
The Sunshine reforms are an overdue dose of medicine to make providers and industry more accountable to the public. For far too long, too little has been known about vast sums of money flowing from industry to doctors. According to the nonpartisan Pew Prescription Project, the drug industry spends $30 billion a year on marketing, mostly on direct marketing to physicians; $1 billion is spent on lunches alone. A groundbreaking 1993 Minnesota law requiring disclosure of many drug company payments found that $104 million went to medical staff, clinics and other organizations in the state between 1997 and 2005.
The financial ties between physicians and the medical device industry are also significant. Last year, a letter from Grassley's office to the University of Minnesota revealed that Dr. David Polly, a faculty surgeon, had received about $1.2 million from Medtronic from 2003 to 2007. A University of Wisconsin surgeon was paid more than $19 million over the same period.
The Sunshine reforms smartly do not ban industry payments to providers, it just makes them public. Cooperation between industry and physicians is critical to develop new drugs, devices and other products. But the depth of those relationships raises critical questions about how money influences the care that patients receive.
Soon patients will be able to weigh their doctors' outside income and decide for themselves. Beginning in September 2013, payment information will be available nationally in a searchable online database run by the U.S. Department of Health and Human Services. According to the Pew Prescription Project, this will likely be a worldwide first. No other country makes this information available so comprehensively. As a world epicenter for medical innovation, the United States should set the standard for this type of disclosure.
A number of medical organizations are ahead of the curve in disclosing payment information. For more than a year, St. Louis Park-based Park Nicollet Health Services has listed on its website payments made to medical staff. This week, a Medtronic spokesman said the company is "operationalizing" website changes to soon begin disclosing some payment information. The 1993 Minnesota law helped pave the way for the Sunshine reforms and two of the state's senators -- Amy Klobuchar and Al Franken -- advocated for them. Minnesota's renowned medical community should also be at the forefront in making this information public.