Welcome to Health Reform Watch, Jason Millman's regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Jason with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition, or sign up here to receive it straight from your inbox. Read previous columns here.
It's one of the more controversial practices that's been long engrained in the health-care system — the hundreds of millions of dollars each year that drug and medical device manufacturers pay doctors to promote their products. The financial ties, which naturally raise conflict-of-interest concerns, aren't always clear, but that's about to change because of a lesser-known Obamacare provision.
Some of the major drugmakers have been reporting some information about financial relationships with care providers — some voluntarily, some as the result of litigation — but a comprehensive nationwide effort is about to launch this summer, and the federal government is now looking to bring even greater transparency. Drug and device companies will now have to report to the government payments to doctors and teaching hospitals of at least $10 (or $100 over the year), and the Medicare agency will soon post the reports in a public database. These reported payments could include things like gifts, speaking fees, research funding and more.
"As a patient, you'll be able to see whether your doctor has a financial relationship with the company," said Allan Coukell, senior director of drugs and medical devices for Pew Charitable Trusts. "Some people may choose to interpret that differently. Some will be concerned about that financial relationship."
There have been some noticeable changes in the health-care industry as companies adjust to the new sunshine requirements. The third-largest drugmaker, GlaxoSmithKline, said in December it would stop paying doctors to promote drugs. ProPublica this year found that drug companies had started to slash how much they spent on doctors to make promotional speeches.
With the backing of Sen. Chuck Grassley (R-Iowa) and former Sen. Herb Kohl (D-Wis.), the federal payment database was one of the bipartisan ideas that made it into the final version of the 2010 Affordable Care Act. Drug manufacturers and medical device companies have been reporting the payments as of last August, and the federal database is set to go live in September, a year later than originally planned.
But even before that happens, Medicare just proposed some tweaks to the program to make it even more transparent. In a lengthy rule issued just before the holiday weekend, Medicare officials said drug and device companies have to report payments according to the marketed product name, which should make it easier to connect payments to specific products.
Medicare also said it will eliminate a reporting exclusion for continuing medical education (CME) programs, which was a big carve out in the program's original design. A Journal of the American Medical Association study found that 14 medical device and drug companies in 2010 paid $657 million in grants to CME organizers. And just last week, Modern Healthcare reported that manufacturers had been looking to exploit the CME reporting exclusion.
Coukell said he sees the Medicare proposal as largely an administrative change that shouldn't affect the CME industry in a substantial way. But a coalition of CME providers, doctors and major drug firms blasted the proposed rule shortly after it was issued, writing that it "inexplicably" eliminated a "narrow, but vitally important exemption" that Medicare provided just a year earlier.
So chalk this up as another health-care fight that isn't quite over.
Top health policy reads from around the Web:
How Obamacare broke up a marriage. "The day Linda Drain put baby's breath in her hair and said 'I do,' she had no idea that government policies would tear her apart from her husband. But 33 years later, she and her husband, Larry Drain, separated so she could keep her health insurance. Six months into the full implementation of the Affordable Care Act, the Drains are among 162,000 Tennesseans who got caught in a coverage gap. Their household income is too little to qualify for a government subsidy to buy health insurance, and they live in a state not expanding Medicaid." Tom Wilemon in the Tennessean.
Gauging Obamacare's performance requires patience. "While sign-ups exceeded expectations, other measures are more important and, at this point, uncertain. For example, relatively few young people signed up. Significantly more females, who are pricier to insure, enrolled than males. And little is known about the overall health of the sign-up group, although early studies suggest they are older and sicker than other insured Americans. ... It will be a year or more before it is clear whether the system has struck the right balance among all of these measures." Jo Craven McGinty in the Wall Street Journal.
The new normal? Long waits for the doctor. "[T]here is emerging evidence that lengthy waits to get a doctor’s appointment have become the norm in many parts of American medicine, particularly for general doctors but also for specialists. And that includes patients with private insurance as well as those with Medicaid or Medicare. ... And those waits are likely to get longer as the Affordable Care Act brings tens of millions of newly insured patients into a system that is often already poorly equipped to provide basic care." Elisabeth Rosenthal in the New York Times.