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< HealthStream Resources

Will The Sun Continue to Shine on Physician Payments?

April 1, 2021
April 1, 2021

By Bill Sacks, Vice President, COI Product Management, HCCS, A HealthStream Company

Physicians, teaching hospitals, and compliance officers around the country, not to mention thousands of pharmaceutical and medical device companies, anxiously await the outcome of the debate in Congress over the future of the Affordable Care Act. Efforts by Republicans in Congress to “repeal and replace” Obamacare have focused on financial aspects of the law, which can be changed using the budget reconciliation process, requiring only a simple majority vote. Changes to other provisions of the law would be subject to filibuster in the Senate, requiring 60 votes to overcome.

According to estimates made by the non-partisan Congressional Budget Office, limiting financial subsidies for the purchase of insurance and changes to the structure of the Medicaid program could reduce the number of individuals with health insurance by as many as 14 million in 2018, and as many as 24 million by 2026. But not known at this time is the impact of these proposed changes on the continued operation of the CMS “Open Payments” database.

In 2010, the Affordable Care Act incorporated elements of the “Physician Payments Sunshine Act,” the bill that had been conceived and championed by Republican Senators Charles Grassley (R-Iowa) and Herb Kohl (R-Wisc). The “Sunshine” provisions created the CMS Open Payments database and required that pharmaceutical and medical device companies report all payments to physicians and teaching hospitals in excess of $10.00. For the last three years the database has provided a trove of information for investigators, journalists, and administrators who believe that the transparency the database provides reduces the risks to patients and the healthcare system arising from unmanaged conflicts of interest.

If the “Repeal and Replace” bill before Congress makes it out of the House of Representatives, it will face an even more skeptical Senate. It has been reported that Senator Grassley will fight any attempts to remove or weaken the existing Sunshine provisions. In fact, Grassley (R-Iowa) and Richard Blumenthal (D-Conn) recently introduced legislation that would expand reporting requirements to physician  assistants, nurse practitioners, and other advanced practice nurses.

The Republicans can only afford to lose three votes in the Senate if they want to pass any version of ACA repeal. The supporters of the Sunshine provisions have a strong ally in Grassley, who is unlikely to support any such version that eliminates the provisions he has championed for more than a decade.

Learn more about COI-SMART, the HCCS solution for managing healthcare conflicts of interest.