Blog | Wednesday, September 11, 2013

New app suggested for Sunshine Act compliance


A few weeks back, a drug rep, aka a pharmaceutical representative, came to the office hawking a new constipation medicine. These guys are in a tough racket. They need to sell products that we physicians are often unable to prescribe. It’s the formulary, stupid.

In the olden days, before I entered the hallowed halls of healing, pharm reps, or drug detailers, developed relationships with physicians who would then prescribe their drugs. Physicians to this day deny the incontrovertible truth that we are influenced by pharmaceutical company marketing techniques, which still feature face time between sales folks and prescribing physicians.

These days, many of the sales tools used years ago have been properly prohibited. Physicians cannot be flown to exotic locales and paid big bucks so they can serve as “expert consultants” who will be subjected to push polling on the new pharmaceutical product. (Why didn’t any company ever ask me to serve as an “expert”?)

As is often the case, the new laws that are designed to promote ethical behavior and restrain corruption have become OperationOVERBOARD. The Sunshine Act, a part of our beloved “Obamacare” Affordable Care Act (ACA), is now fully operational. Pharmaceutical companies are now required to report to the federal government if a physician receives an individual item valued at $10 or more, or accrues an annual total of more than $100. These “transfers of value” will be posted for public viewing.

We physicians do not want to be on the government’s Sunshine Act Wall of Shame, which conveys that we are evil and corrupt practitioners. Will the public really be able to distinguish a tainted doctor who has taken possession of a $12.99 tote bag from another rogue who has acquired a $14.95 breakfast tray for the staff? Did the ACA consider that these dilemmas will vex and torture patients who may miss their doctors’ appointments as they will be spending so much time scrolling through the roles of tarnished physicians? This will directly and negatively impact on their health. The ACA should have had their IT folks incorporate a time limit on Sunshine Act website viewing. This is an individual mandate that I could enthusiastically support.

Here’s how I intend to remain just under the government’s radar, although we are now learning that government surveillance is slightly more intrusive than it has admitted.

Consider these contraband items:
Tuna sub: $5.99
Tuna sub with cheese” $7.49
Medium size beverage: $1.69
Large size beverage: $2.19
Chips” $0.89
French fries: $2.49
Cheese fries: $2.99
Cookies: $0.99

I will assume that the $10 total includes sales tax, but I will have to consult my accountant and attorney to verify this. Obviously, if tax is excluded then I will have more funds available and would probably be able to add a peppermint patty to my food order while remaining comfortably under the mandated threshold.

Although I enjoy cheese, and I am fortunate not to suffer the dreaded disease of lactose intolerance, I will order a cheeseless tuna sub so that I will have greater ordering flexibility. I now have $4.00 left to spend, leaving aside the critical tax issue referenced above. Readers who are computationally advantaged have already determined that I cannot enjoy a large size beverage along with cheeseless French fries. Even a medium size beverage will put me over the limit. I could order any beverage size with either chips or cookies. I don’t really like these two items, but if eating vitamin fortified potato chips and omega-3 laced cookies will keep me off the list, then I will do the right thing.

I suggest that an entrepreneurial whiz kid design an app that can instantly provide physicians with all permutations of menu choices from area restaurants that will not cross the Sunshine Act’s $10 limit. Hurry before Yelp administrators, who are avid Whistleblower readers, incorporate this feature into their app.

Does anyone out there think that our government needs a little sunlight shining on it?

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.