Physician Conflict of Interest Reporting Requirements

The Physician Payments Sunshine Act was adopted as part of the Patient Protection and Affordable Care Act in 2010. The act allows patients to know if their physician may have an outside motivation when providing care, such as incentives provided by medical product manufacturers. These incentives could include simple monetary payments or any type of transfer of valuable goods. By making this information public, the hope is to ensure that physicians make the best possible decisions for their patients, not their own personal interests.

The Act requires physicians to disclose to the Centers for Medicare and Medicaid Services (CMS) any payment or “transfer of value” made to the physician or teaching hospital by a medical product manufacturers. This Act also requires a group purchasing organization or medical manufacturer to disclose any physician ownership. The information is then published online for patients and others to research, with the first set of data published in 2014. Despite the initial publication, CMS withheld some information due to technical difficulties and the outcome of this publicity remains unclear. For 2015 and 2016, CMS implemented changes to the reporting process for physicians as a result of the first release.

Despite the lack of clarity surrounding the outcome of making this information public, some lawmakers are trying to expand the law to include nurse practitioners and others that have prescribing authority. However, at the current time, the law remains limited to physicians, medical product manufacturers, and group purchasing organizations. To view the information and search for physicians, please visit the following website:

© 2015 Houghton Vandenack Williams
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Plan to Repeal SGR, Revamp Physician Compensation Introduced

A bipartisan Congressional group introduced a new bill that would drastically change physician compensation. The SGR Repeal and Medicare Provider Payment Modernization Act would repeal the SGR and provide for flat payment increases of .5% per year until 2018. At that point, payment would shift to an incentive-based structure.

The proposed incentive-based structure, called MIPS, consolidates the PQRS measures, Meaningful Use requirements, and the Value-Based Payment Modifier. By doing so, the bill hopes to enable an orderly transition to an alternative, value-based payment structure. However, the proposal does not address funding, which may be a difficult sticking point between the parties. Analysts estimate that the cost of repealing the SGR would be between $100 billion and $250 billion over the next ten years.

© 2014 Parsonage Vandenack Williams LLC

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New Commission Formed to Analyze Physician Payments

The National Commission on Physician Payment Reform has been established by the Society of General Internal Medicine to make recommendations about physician payments.  The commission will meet over the next year to look at how doctors are paid, and to analyze how accountable care organizations, medical homes and other arrangements will affect healthcare financing.

The Robert Wood Johnson Foundation, the California HealthCare Foundation and the Sergei S. Zinkoff Fund for Medical Education and Research will provide funding for the commission, according to Family Practice News.

The commission plans to issue its own report on reforming the healthcare payment system by early 2013.

© 2012 Parsonage Vandenack Williams LLC

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Medicare Physician Payment Freeze Now to Occur May 31

The Continuing Extension Act of 2010 has been signed into law, extending through May 31, 2010, the zero percent update to the Medicare Physician Fee Schedule that was in effect for claims with dates of service January 1, 2010 through March 31, 2010.  The law is retroactive to April 1, 2010.

Effective immediately, claims with dates of service April 1, 2010 and later, which were being held by Medicare contractors, are being released for processing and payment.  Remember that the statutory payment floors still apply, so clean electronic claims cannot be paid before 14 calendar days after the date they are received by Medicare contractors (29 calendar days for clean paper claims).

© 2010 Parsonage Vandenack Williams LLC

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