The Sunshine Act Simplified
As a sales representative, you may have fielded questions from dental teams about the impact of health care reform’s Sunshine Act, which requires medical device and/or supply manufacturers to report to the Centers for Medicare and Medicaid Services (CMS), a division of the U.S. Department of Health and Human Services, payments or transfers of value to dentists and dental educators. To help you better answer these inquiries, the Dental Trade Alliance (DTA) has created this seven-point guide:
- The minimum value (or threshold) of what has to be reported is $10 per transfer of value, or a cumulative total of $100 per year.
- There is no requirement to report payments made through third parties in cases in which the manufacturer does not know the identity of the dentist or "physician learners."
- Gifts — identified as transfers of value — could include cash payments (e.g., honorariums), food or entertainment expenses, travel or trip reimbursements, merchandise, equipment, paid leases and more.
- The reported information will be made publicly available by September 2014, with subsequent releases each following quarter. (This is the "transparency" that earned the name, the "Sunshine Act.")
- When reporting to the CMS, the company providing the gifts must include the name of physician or teaching institution; his or her (or the business) address; his or her specialty; his or her national provider number; the amount of the payment or other transfer of value; the date the payment or transfer of value was provided; and the nature of the payment.
- Fines of up to $10,000 can be levied for each failure to report, but, cumulatively, are not to exceed $150,000 annually.
- For each knowing failure to report, fines of up to $100,000 are possible (not to exceed $1 million annually).
The DTA has joined forces with other dental organizations to fight the Sunshine Act on the basis that it represents an unfair burden on dental professionals and the industry because only about 25% of dentists participate in CMS programs. In fact, in many states, Medicaid payments to dentists are actually well below their costs to provide these services. It’s also worth noting that expenditures for dental services covered by Medicare represent less than 1% of total expenditures in CMS programs.
While the Sunshine Act’s transparency is supposed to help prevent manufacturers from exerting undue influence on dentists and dental educators — and thus help keep CMS costs in check — the small percentage of CMS expenditures on dental services does not warrant the dental industry’s inclusion in the act. Furthermore, the financial burden of the complex reporting requirements far outweighs any intended benefit, as the added costs will be passed along to providers and patients — the great majority of whom do not participate in the very CMS programs the Sunshine Act is supposed to safeguard.
EDITOR’S NOTE: You can find updates on this topic by "friending" DTA on Facebook (facebook.com/pages/Dental-Trade-Alliance/160917053994300), following it on Twitter (@DTANews), or by visiting dentaltradealliance.org.