Building our advocacy arm's muscle

From the President

Dr. Lebwohl

Dr. Lebwohl is the Academy's current president.

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In my column last month, I sang the praises of our specialty’s powerful advocacy arm. Our advocacy efforts — at the grassroots level and through the Academy’s D.C. office — were instrumental in influencing the successful passage of a historic Medicare payment reform bill in Congress. But as you’ll note in this month’s “Strength in numbers” article in Dermatology World, there is a litany of issues — major and minor — that we have affected because of the alliances we formed with other specialties and the greater house of medicine. One issue that has bubbled up over the last few months that has been particularly troublesome is that companies are required to report the provision of educational materials to physicians on the Open Payments site.

The Open Payments (Sunshine Act) site is a portal that highlights the financial relationships between health care providers and the pharmaceutical and medical device industries. The Sunshine Act requires companies to report the provision of educational materials to providers — such as textbooks, reprints of peer-reviewed articles, and journals. Each drug company interprets the Sunshine Act differently which has led to differences in reporting patterns from one company to another. For example, some companies report the value of services provided in the creation of posters and helping write or edit scholarly articles. The values assigned to each of these activities vary tremendously from one company to another. Some physicians have removed their names from scholarly efforts such as posters to avoid any value being attributed to them on the CMS website listing payments from industry.

Physicians are wary about having this information displayed for the public’s viewing because it could garner unwarranted negativity toward our practices and our specialties. According to CMS, one million people have reviewed the 2013 data on the Open Payments website — which includes about 4.45 million public records, representing $3.7 billion in payments — so we know that the public is curious about this information. However, the information that is reported can be misleading. It can take up to several hours to get into the Open Payments website to review your records, and if you can manage to get into the site, you might be surprised to see exorbitant dollar amounts attributed to your name. That is because these companies are reporting the provision of these educational materials in cash amounts without providing context for what the amount represents. For example, if a rep stops by and brings you a reprint of an article, they will attribute a dollar amount to your name on Open Payments to represent the value of that article.

Over the past year, I had the experience of writing an article with a medical student on a new therapy. The manufacturer of that therapy learned about the article and offered to submit the article for us. At first we thought that would save us the trouble of submitting the article ourselves. However, the drug’s manufacturer would have attributed $30,000 to my name on Open Payments for their submission of my article. I don’t know how they decided to value that service at $30,000, but we submitted the article ourselves to avoid the declaration on Open Payments. This is happening elsewhere too. I recently heard from a colleague that he visited a website that was sponsored by a pharmaceutical company, and the company declared the cost of a subscription to that site on his Open Payments account. While I understand that companies are trying to protect themselves against compliance issues with the Sunshine Act, to our patients it looks as if we have received a gift from a drug company.

This issue, albeit very troublesome to dermatologists, doesn’t just affect our specialty. Physician, patient, and other medical groups are all concerned about how these reporting requirements are going to affect the distribution of medical knowledge and the development of innovations in medical research. Clearly, this issue is ripe for collaboration. Rest assured that your Academy has hit the ground running. We have already joined up with about 115 other medical organizations and signed on to a letter that supports legislation (H.R. 293) which calls for a reporting exemption for the provision of educational materials. As a specialty, we will continue to push for a resolution to this issue, but with these other medical associations by our side, we will be more effective. We have to remember that as a specialty we are not an island, and many of the issues that we find disconcerting are troubling to other groups as well. I am pleased that as a specialty, we have been open to collaborating with others, because when we flex our collective muscle, the people who make the policies that affect our patients and practices take note and, subsequently, take action.

However, I also encourage all members to take matters into their own hands by reviewing their information on the Open Payments site. If you have any questions about the reporting requirements or want to know how to dispute something on your record, the Academy has developed a Web page devoted to explaining the ins and outs of the Sunshine Act. Get familiar with the information on the AAD's website. If you have any questions, contact your Academy staff online or call your Member Resource Center at (866) 503-7546.