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What the US is doing about conflicts of interest in health and medicine

Health reform efforts in the US are not only attempting to improve access, efficiency and quality of care. They are also seeking to inject greater transparency into the relationships between industry and health care providers, reports Dr Lesley Russell from Washington. It seems that sunshine may be the best disinfectant, she says. She writes:

The 1000 plus pages of the House of Representatives tri-committee health care reform bill (available here) contains an extraordinary number and range of provisions, written in incredibly detailed legislative language.

One provision that has been lost in the debate around costs and financing is one headed “Physician Payments Sunshine Provision”.

This requires manufacturers or distributors of medicines, medical devices, biologicals and medical supplies which are covered by Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) to make an annual electronic report to the Department of Health and Human Services about any payment, services or items above $5 in value made to doctors and health care professionals, hospitals and other entities that receive Medicare funding.

These requirements apply to just about everything that could conceivably be provided to a doctor or a health care service, including drug samples and medicines and devices used in clinical trials and studies.  There are penalties of up to $150,000 a year for non-compliance.

The reporting, to be implemented by March 2011, is quite detailed:

  • The recipient’s name, business address, physician specialty, and national provider identifier
  • A description of the payment, item or service, its value and the date it was delivered;
  • The name, number, date, and dosage units of any drug samples.

This provision also requires a report to the Secretary of any ownership shares held by a physician in a hospital or other health service.  Elsewhere in the bill there are provisions that limit doctors’ ability to refer patients to hospitals in which they have a direct financial interest.

All this information, with the exception of that about drug samples, but including any enforcement actions taken, is to be made publicly available on a Departmental website that is searchable and in a format that is clear and understandable.

It’s interesting to speculate how such a requirement would be viewed in Australia.

And it’s worthwhile noting that here in the US, the pharmaceutical industry is showing their support for this bill by providing $100 million in advertising, and the American Medical Association has publicly stated their support for the bill in a letter to the Chairmen of the relevant House Committees.

• Dr Lesley Russell is the Menzies Foundation Fellow at the Menzies Centre for Health Policy.  She is currently a Visiting Fellow at the Center for American Policy in Washington DC.

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