Deciphering the Sunshine Act

Abstract

The Physician Payments Sunshine Act ("Sunshine Act"), enacted to address financial conflicts in health care, is the first comprehensive federal legislation mandating public reporting of payments between drug companies, device manufacturers, and medicine. This article analyzes the Sunshine Act's uneven record, exploring how the law serves as an intriguing example of the uncertain case for transparency regulation in health care. The Sunshine Act's bumpy rollout demonstrates that commanding transparency through legislation can be arduous because of considerable implementation challenges. Capturing all the relevant information about financial relationships and reporting it with sufficient contextual and comparative data has proven disappointingly difficult. In addition, the law suffers from uncertainty and poor design as to the intended audience. Indeed, there is strong reason to believe that it will not significantly impact decision-making of primary recipients like patients. Yet the Sunshine Act nonetheless retains important and perhaps underappreciated value. From the almost four years of information generated, we have learned that industry-medicine financial ties vary significantly by physician specialty, and somewhat by physician gender. In many medical fields the distribution of top dollar payments tends to be heavily skewed to a few recipients, all of which have important implications for optimal management of financial conflicts and for health policy more generally. Accordingly, the Sunshine Act's greatest potential is not guiding decisions of individual patients or physicians, but its downstream effects. This Article traces how secondary audiences, such as regulators, watchdogs, and counsel are already starting to make productive use of Sunshine Act information. Public reporting has, for example, made more feasible linking industry payment information with Medicare reimbursement data. As a result, policymakers can more closely examine correlations between industry spending directed at individual physicians and their prescribing and referral decisions. Moreover, savvy counsel are recognizing that Sunshine Act information provides explosive evidence in private civil litigation and this Article explores the first wave of cases.

Price transparency in Iranian healthcare market

“…While price transparency policies have yet to be implemented in Iran, experts opine that their proper execution will lead to the selection of superior treatment options, improved service quality, enhanced client satisfaction, reduced demand, and lower service costs. It is worth noting that Richard S. Saver et al [25] underscore the broader ramifications of price transparency, extending to the realms of social justice, corruption mitigation, the delivery of safer, more effective, and ethically sound healthcare services, the reinforcement of the healthcare system's accountability, and the fortification of trust between the government and the public.…”

“…As Richard S. Saver et al [25] articulate, price transparency holds substantial potential for promoting social justice, reducing corruption, ensuring safer, more effective, and ethical healthcare services, increasing healthcare system accountability, and bolstering public trust in government healthcare oversight. Empirical evidence from numerous studies has confirmed the cost-saving effects of price transparency across various healthcare services, including radiography, dental care, non-emergency medical services [16] , management of pre-diagnosed medical conditions, outpatient care [26] , routine medical procedures [27] , and even high-cost interventions such as cancer treatment [28] .…”

Policies on doctors’ declaration of interests in medical organisations: a thematic analysis

“…20 However, even when commanding transparency of financial interests through legislation, such as in the case of the Physician Payments Sunshine Act in the U.S., implementation can be inconsistent, arduous and the data difficult to interpret in the absence of contextual and comparative information. 21 Inconsistencies in the disclosure and management of doctors' COIs are likely to exist beyond industryrelated financial interests and beyond research and academic settings. With the expansion of flexible working and of opportunities to engage in a variety of roles within provider and commissioner organisations, as well as professional bodies, it is likely that an increasing number of doctors may find declaring their interests and complying with the different organisational policies challenging.…”

“… 20 However, even when commanding transparency of financial interests through legislation, such as in the case of the Physician Payments Sunshine Act in the U.S., implementation can be inconsistent, arduous and the data difficult to interpret in the absence of contextual and comparative information. 21 …”