Old DRG, heart failure/shock: 1.0490.
New MSDRG, heart failure/shock:
- With MCC: 1.2565;
- With CC: 1.0134; and
- Without CC: 0.8765.
I recently spoke with a hospital administrator at a large urban teaching hospital. Nearly a quarter of the hospital’s Medicare inpatients have heart failure. How physicians document heart failure represents a significant opportunity for hospital revenue ($3 million to $5 million a year). Because of this, I expect you are not alone. Hospital administrators all over the country are likely speaking with their hospitalists about their documentation.
Question: A pharmaceutical company offered an honorarium for me to give a talk. I heard from a colleague that the company is required to report this payment to the government, which makes this information publicly available. Is this true?
Dr. Hospitalist responds: The answer presently depends on where you live. Five states (California, Maine, Minnesota, West Virginia, Vermont) and the District of Columbia have some form of mandatory disclosure of payments made to physicians by pharmaceutical companies.
Minnesota and Vermont make this information publicly available. Other states may not be far behind. In 2006, 11 states considered similar legislation. But according to Ross, et. al., “the Vermont and Minnesota laws requiring full disclosure of payments do not provide easy access to payment information for the public and are of limited quality once accessed.”1
Proposed federal legislation may resolve this issue. Last fall, Sen. Charles Grassley, R-Iowa, introduced a bill called the Physicians Payments Sunshine Act of 2007. This bill would require drug and device manufacturing companies with more than $25 million in annual revenues to report all gifts in excess of $25 in value to physicians and other prescribing clinicians.
Drug/device samples and payment for clinical trials would be exempt. This data would be available in a public, searchable online database. Companies that fail to disclose would face penalties $10,000 to $100,000 for each undisclosed physician payment.
Industry support has been and will continue to be a controversial issue. Many doctors do not believe honoraria influence prescribing. But it is clear financial payments from industry are facing increasing scrutiny. You’ll need to decide whether you’re comfortable accepting this honorarium if your name will be listed on a publicly available database. TH
- Ross JS, Lackner JE, Lurie P, et al. Pharmaceutical company payments to physicians: early experiences with disclosure laws in Vermont and Minnesota. JAMA. 2007;297(11):1216-1223.