Robert Dickson writes a letter to Congressman Keith Rothfus arguing that the Physician Payments Sunshine Act is overly burdensome and does not achieve its objectives. Dickson asserts that requiring reporting of small individual payments and transfers of value wastes resources. Additionally, CMS does not provide guidance on differentiating beneficial relationships from those representing conflicts of interest. Dickson believes conflicts of interest are better evaluated by hospitals and that the regulations duplicate other laws. He concludes that Congress should eliminate the Sunshine Act portion of the Affordable Care Act.

1. Robert J. Dickson
600 Georgetowne Court
Wexford, PA 15090
724-272-1527
June 11, 2015
The Honorable Keith Rothfus
United States Houseof Representatives
1205 Longworth Building
Washington, DC 20515
RE: The Physician Payments Sunshine Act
Dear Congressman Rothfus:
The AffordableCare Act (ACA) has been controversial. One seemingly small part
of ACA constitutes regulatory overkill and takes productiveresources away from
more important aspects of providing high quality healthcare to patients. This
section of the ACA, The Physician Payments SunshineAct (“Sunshine”), is
reporting of payments and financial relationships between physicians and
teaching hospitals and manufacturers of medical products. This section of ACA is
administered by the Centers for Medicare and Medicaid (“CMS”)
The Objective of the Regulations Cannot Be Met
The intent of the law is to identify which financial relationships are beneficial or
which may causeconflicts of interest. However, CMS does not take a position
on which are beneficial and which may resultin conflicts of interest but rather
believes that transparency willdiscouragethe the development of inappropriate
relationships. Once disclosed, how is the public or patient to make a decision on
which relationships are beneficial and which may causea conflicts of interest if
CMS does not? Even if the public/patient would quiz a doctor or a hospital
administrator about a financial relationship it is doubtful that a conclusion about
a conflict of interest could be reached. Accordingly, the objective of Sunshine
cannot be met.

2. Amounts toBe ReportedAre TooSmall
The regulations require that all individual transactions in excess of $10 or more
than $100 a year in the aggregatebe reported. This results in a large number of
transactions individually in excess of $10 being reported that do not exceed $100
per year in the aggregate. The reporting of large number of small payments
wastes the time of manufacturers, hospitals, doctors and CMS. So consideration
should be given to not requiring individual payments of small amounts to be
reported unless they exceed a reasonabledollar threshold. This will enable
everybody to focus on the larger amounts that would be morelikely to result in a
conflict of interest. Does anyonereally believe that a conflict of interest could
exist for an amount, say for the allocation of the costs of a group purchaseof a
dinner, say for $11?
CMS OverreachonTransfers of Value
The concept of transfers of value is nebulous and results in items being identified
as transfers of value that are an overreach by CMS. For example, manufacturers
attempt to supportvalid independent medical education. Now CMS has
proposed that companies that distribute peer-reviewed literature to physicians
reportthose distributions as payments to physicians. H.R. 293, introduced by
Congressman MichaelBurgess, MD, R-Texas, would halt CMS's planned
expansion, if passed. Along with mostmedical associations wesupportH>R>
293, butit does not go far enough.
Reporting Results is aDuplicationof Effort
Hospitals generally havecodes of conductthat doctors need to comply with and
these codes of conduct frequently require reporting of conflicts of interest.
Accordingly, the Open Payment regulations are frequently duplicating the efforts
of hospitals to avoid physicians’ conflicts of interest. The reporting and the
evaluation of conflicts of interests should be left up to the govern bodies within a
hospital since they are closer to and can investigate the issues.
In addition, doctors and manufacturers arealready required to comply with other
conflict of interest laws such as the Stark Act. The Open Paymentregulations
duplicate the intent of other laws dealing with conflicts of interest. Layers of
additional regulatory requirements that CMS do not forman opinion will not
reduce potential conflicts of interest.

3. Physician SpecialtiesUnrelated toBusiness.
A business mighthave products that are marketed to only one or a few physician
specialties. For example an orthopedic products company may only market to
orthopedic surgeons. However, an officer of a company might be related to a
physician in another specialty or a physician that is a member of the board might
have another specialty. The regulations require that all transfers of valueto
physicians even if they have specialties unrelated to the business be reported.
So, for example, if the company markets a productonly sold to orthopedic
physicians, buta company officers wife is a cardiovascular pediatrician, the
company mustreport reportany Christmas presents in excess of $10 that he
purchased for his wife. This seems a little unreasonable.
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Based upon the above observations, Congressshould eliminate the Physician
Payments SunshineAct that is part of ACA. There is little sense in attempting to
change a regulation that will not meet its objectives.
Sincerely yours,
Robert J. Dickson
Robert Dickson is chief financial officer of CardiacAssist, Inc., a medical device
company headquartered in Pittsburgh, PA. The opinions in letter are thoseof
Robert Dickson and not those of CardiacAssist, Inc.