Physician Fee Schedule Impacts the Open Payment Database
One of the provisions of the 2015 physician fee schedule for 2015 eliminates an exclusion from the Sunshine Act.
- Earlier this week, we covered the physician fee schedule for 2015 that was released by the Centers for Medicare & Medicaid Services and the Department of Health and Human Services. The 1,100 page document covers nearly the entire healthcare industry. However, there is one area that deserves a deeper examination.
Over the last few months, some of the biggest news in the payment side of healthcare has been the Sunshine Act and the open payment database. This is part of a larger effort to help consumers understand the financial relationship between the healthcare industry, and physicians and teaching hospitals. Part of the physician fee schedule will impact the Sunshine Act as it eliminates a reporting exclusion.
The exclusion applies to certain payments or other transfers of value made by a manufacturer or group purchasing organization (GPO) to a speaker at a Continued Medical Education (CME) program. It allowed payments or other transfers of value to not be reported if it met one of several conditions which includes accreditation or certification standards and not being paid directly.
However, in the proposed 2015 Medicare physician fee schedule, CMS reasons that the CME Exclusion was redundant with other exclusions that applies to indirect payments or other transfers of value where an applicable GPO is unaware of the identity of the Covered Recipient and/or physician owner/investor during the reporting year or by the end of the second quarter of the following reporting year.
The law firm McDermott Will and Emery penned an article that examined this new rule and what the effect of eliminating exclusion could be.
“By finalizing its proposal to remove the CME Exclusion without further changes to the Indirect Exclusion, CMS’s approach results in an ambiguity regarding the reportability of payments or transfers of value that would have fallen within the scope of the CME Exclusion, where the Applicable Manufacturer or Applicable GPO funds a physician speaker for a CME event and learns the identity of the physician speaker by the end of the second quarter of the following reporting year,” the post reads.
The CMS final rule also addresses some of the concerns and comments that were brought-up during the comment period. Some of the more pertinent comments include:
Removal of speaker compensation will remove exclusion for attendees – The exclusion for attendees is not intended to be removed, but physician speaker compensation and physician attendees fees which have been subsidized through the CME by an applicable manufacturer should be reported.
Interpreted proposed removal to expand exclusion to account for CME for nurses, optometrists, pharmacists and others – The removal of the exclusion does not intended to expand a separate exclusion. The intent is to allow for consistent reporting and transparency.
