by Jennifer Palcher-Silliman, Director of Content and Education, HCEA

Most healthcare associations do not collect the National Provider Identifier (NPI) numbers of their convention attendees, yet disclosure of the NPI number by pharmaceutical and medical device exhibitors is required by the 2010 federal Patient Protection and Affordable Care Act (PPACA).  Being out of compliance can impact decisions about exhibiting and sponsoring, which is why medical associations and their exhibitors are looking for a solution now.

The mandate to disclose NPI numbers is included in what are commonly called the law’s Sunshine provisions, which require the electronic disclosure to the Department of Health & Human Services (HHS) of any “payment or other transfer of value” given to a physician.  Healthcare associations who hold conventions and exhibitions can help healthcare firms with this compliance by collecting the NPI numbers of their healthcare provider attendees and providing those numbers to the healthcare convention marketers and exhibitors who participate in their meetings.    

Important to know:

• The Sunshine provisions originated in a stand-alone bill, but were eventually wrapped into the overall PPACA.  The provisions require that healthcare companies disclose gifts and other items they give to physicians.
• One mandate in the Sunshine provisions is that healthcare companies report the NPI numbers of physicians to whom they give items of value.
• Healthcare convention marketers and exhibitors are asking the organizers of healthcare association conventions to provide the NPI numbers of their healthcare professional attendees, yet most healthcare associations are not currently collecting these numbers.
• Because healthcare companies must begin disclosing information on activities starting in 2012, it is critical that healthcare companies and associations work together to create solutions for the collection and reporting of NPI numbers.
• The implementation rules for the Sunshine provisions are expected to be released in October 2011.

Background on the Sunshine Provisions
The Sunshine provisions originated in a stand-alone bill known as the Physician Payments Sunshine Act, which was first introduced in the U.S. Senate in 2007.  When Congress was working on early versions of the healthcare reform bill in 2009, it decided to include language from the original Physician Payments Sunshine Act.  In March 2010, President Obama signed the PPACA, and the Sunshine provisions became law.  View the actual language of the Sunshine provisions.

The Sunshine provisions go into effect March 31, 2013; at that time healthcare companies must begin reporting activities going back to 2012, which explains why many healthcare companies are preparing for compliance now.  The act mandates that items of value given to physicians or teaching hospitals be disclosed, and at this time it does not expressly mention that any other types of healthcare professionals, such as nurses, would be included in the scope of the law (though there have been reports the provisions may be expanded to include nurses and other healthcare professionals – see below for more information).  Many different kinds of “transfers of value” are included in the law:

(I) consulting fees;
(II) compensation for services other than consulting;
(III) honoraria;
(IV) gift;
(V) entertainment;
(VI) food;
(VII) travel (including the specified destinations);
(VIII) education;
(IX) research;
(X) charitable contribution;
(XI) royalty or license;
(XII) current or prospective ownership or investment interest;
(XIII) direct compensation for serving as faculty or as a speaker for a medical education program;
(XIV) grant; or
(XV) any other nature of the payment or other transfer of value (as defined by the Secretary).

(vii) If the payment or other transfer of value is related to marketing, education, or research specific to a covered drug, device, biological, or medical supply, the name of that covered drug, device, biological, or medical supply.

It is unclear what would be considered an “education” or “research” transfer of value.

The NPI Number
The law lists the types of information that must be disclosed starting in March 2013 including:

The business address of the covered recipient and, in the case of a covered recipient who is a physician, the specialty and National Provider Identifier [NPI] of the covered recipient.

According to the HHS website:

The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty.
For more about the NPI number, visit the HHS website. 

Healthcare companies have started requesting that associations at whose meetings they participate in as exhibitors provide the NPI numbers of healthcare professionals who attend the meetings.  However, HCEA has learned that very few, if any, healthcare associations are currently collecting the NPI numbers of their healthcare professional attendees.  Discussions with HCEA’s healthcare association members have shown that beginning to do so will require considerable quick planning and adaptation.  A dialogue between healthcare companies and associations to come up with solutions for standardized collection of NPI numbers has already begun. 
Also, some healthcare corporations are working to create transparency systems now to comply with their companies’ own corporate integrity agreements (CIAs) that include disclosure programs.  These agreements are already in effect for many companies, so the standardization of means to collect information, such as NPI numbers, is already being implemented. More information on CIAs.

There are reports that some healthcare providers are hesitant to supply their NPI numbers because they fear doing so would expose them to fraud and abuse.  However, NPI numbers are already readily available at several public websites including:  https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do

Implementation, Status of Law
Complicating the issue is that, for now, many of the details of the Sunshine provisions are still open to interpretation, and there are even reports that some of the language may be revised.  As mentioned above, the Senate Aging Committee (which originated the Sunshine language) is reportedly considering expanding the Sunshine provisions to include “payments and gifts to nurses, pharmacists and other non-physicians who prescribe drugs, as they do for doctors,” according to an article in the November 4, 2010, edition of CQ [Congressional Quarterly] Roll Call.  (To see the article, visit page 82 of the publication.) 

Also, HHS is working on the implementation rules for the law, which will include details on how healthcare companies are supposed to disclose information to the agency and how the agency will make the information public, but those aren’t expected until October 2011.

There has been much talk lately about the possible repeal of the PPACA, and the recent ruling by a federal judge in Florida that the whole law is unconstitutional has helped to fuel speculation on the issue.  Early media reports have suggested that if the U.S. Supreme Court reviews the case, it may be unlikely that it would rule the entire law unconstitutional.  Yet it remains to be seen when or even if the Supreme Court will hear the case.

It’s important to note that the Sunshine provisions, going back to when they were part of a stand-alone bill, have consistently had bi-partisan support.  Still another consideration to watch is how Congress decides to provide funding for the implementation of the PPACA; if Congress decides to cut funding for certain elements of the law, it is unclear what the effect would be on the Sunshine provisions.

HCEA is forming a task force to examine the issue, explore best practices and maintain a dialogue between all industry participants that will be affected by this issue. For more information contact hcea@kellencompany.com.

Related Resources

• HCEA's Compliance Resource Center and Matrix of State Laws (Members-Only)
• How the Healthcare Reform Law is Expected to Affect the Healthcare Convention Marketing
  and Exhibitions Industry