1. An Introduction to the Sunshine Act
Health Care Industry Committee
An Introduction to the Sunshine Act
Ready-to-Use Presentation Slides

2. Introducing the Sunshine Act
Pharmaceutical, Device Companies Required to Report Gifts to Physicians
Anticipated Effect of the Sunshine Act
Close Monitoring of Value Transfers
Applicable manufacturers required to closely track value transfers made to physicians
Increased Transparency
Patients, prosecutors, and public interest groups can access information on value transfers
Greater Potential for Fraud, Abuse Complaints
New transparency requirements mean that physicians are more likely to face fraud and abuse claims
Law in Brief: The Open Payments Program (“Sunshine Act”)
Passed as part of the Patient Protection and Affordable Care Act (ACA)
Requires “applicable manufacturers” (like pharmaceutical and medical device companies) and Group Purchasing Organizations to annually report to CMS any payments or transfers of value they make to physicians and teaching hospitals in excess of $10
Reported information will be made publically available online
Source: Advisory Board research and analysis.

3. From Recording to Reporting
Breaking Down the Sunshine Act’s Reporting Cycle 1 2 3
Pharmaceutical, medtech firms transfer value to physician(s)
Firms submit information to CMS outlining value transfers made that year
Physicians, medical groups have 45 days to review submitted information 6 5 4
Reported information updated during subsequent data releases
Reported information is made public, accessible online
Manufacturers have 15 days to resolve data disputes
Source: Advisory Board research and analysis.

4. Establishing a Timeframe for Change
CMS Begins an Annual Reporting Process
Key Dates in the 2013 Sunshine Act Reporting Period
What Gets Reported
Aug. 1 – Dec. 31, 2013
Applicable manufacturers collect data on value transfers made to physicians
September 2014
CMS releases an online database of the reported information to the public
Physician information:
Name
Business address
National Provider Identifier (NPI) number
Transaction information:
What was transferred
Value of goods, money transferred (including gifts, meals, speaking fees, etc.)
Nature of the transaction
Date it occurred
March 31, 20141
Deadline for applicable manufacturers to report data to CMS
Beginning an Annual Process
In subsequent years applicable manufacturers will track information over 12 month intervals
After 2014 the deadline will be 90 days after the new year begins
Source: Advisory Board research and analysis.

5. Medical Groups Looking to Limit Risk!
Can Medical Groups Get Away With Doing Nothing?
Although physicians and medical groups are not legally required to do anything to comply with the Sunshine Act, legal consultants from the firm Krieg Devault recommend that medical groups take the following steps to limit the risk of negative repercussions resulting from the act’s transparency requirements 1
Update Medical Group Policies
Medical groups should make sure that their employment agreements, compliance policies, and conflict of interest disclosure procedures are up-to-date and ensure accurate financial records 2
Request a Pre-Submission Review
To avoid false reporting, medical groups that know they will be reported on under the Sunshine Act should request to conduct a pre-submission review with applicable manufacturers 3
Actively Monitor any Information Submitted to CMS
Medical group leaders should set aside time in April and May to take advantage of the 45-day window to review information submitted to CMS about their physicians 4
Require Physicians to Notify Medical Group Leaders of Outside Activities
Groups should require their physicians to notify administrators of any activities they participate in that could be affected by these new transparency regulations
Source: Advisory Board research and analysis.