Policy and Political Action

Policy & Political Action

Submission on proposed new regulation made under the Health Sector Payment Transparency Act, 2017

Introduction

RNAO is pleased to offer its submission on the draft regulation under the Health Sector Payment Transparency Act, 2017, (HSPTA) posted to Ontario's Regulatory Registry on Feb. 21, 2018. The Health Sector Payment Transparency Act, 2017 was created by Schedule 4 of Bill 160, the Strengthening Quality and Accountability for Patients Act, 2017. According to the Ministry of Health and Long-Term Care (MOHLTC), the latter was designed to support Ontario's Patients First: Action Plan for Health Care.

RNAO welcomed Bill 160's objectives of strengthening transparency, accountability, and quality of care in a person-centred health system. RNAO's submission recommended the government "proceed to require public disclosure of payments and transfers of other value from the medical industry to health-care professionals and to organizations. Ensure that the reporting threshold is very low and that there are few exemptions." The submission went further, urging the government to "[b]an the practice by the medical industry of providing payments and transfers of other value to health-care professionals and to organizations." Bill 160 did not go that far, but it did require payors from the medical industry to report direct or indirect transfers of value beyond a prescribed threshold. That was an important step forward.

The draft regulation details which recipients of transfers of value are included; the definition of transfer of value; exemptions from reporting requirements; which payors are included; which intermediaries are included; the information that is to be reported; the manner and frequency of reporting; the date the regulation would come in force; the procedure for payors to correct information provided by payors; record retention requirements; exclusion of non-medical cannabis; and the method of serving compliance orders.

RNAO's general comments

RNAO recommended a complete ban on transfers of value to health professionals and other recipients, as this approach would have the greatest impact in reducing the influence of transfers of value on health professionals' practice (e.g., prescribing a drug from a supplier who donates generously). While the legislation did not reflect this recommendation, RNAO recognizes that providing clear reporting on transfers of value will go a long way to increase transparency concerning the links between health-care professionals receiving transfers of value and those entities providing transfers of value. This will allow users of the health system to be better informed on the influences on health professionals' practices, and will deter inappropriate transfers that must now be disclosed.

The draft regulation

The draft regulation casts its net widely, and we applaud that approach. In particular, the definitions of recipients, and of transfers of value, are designed to capture the full range of each. RNAO has concerns about some of the exemptions, which would afford opportunities to circumvent the transparency which the Act is designed to deliver. We welcome the inclusion of pharmacies, laboratories and specimen collection centres as payors in the draft regulations; the failure to do so would be a significant omission. The draft regulation also spells out the information which must be provided; that information is essential for any health system user to judge the relationship between a providing entity and the medical industry.

Summary of RNAO recommendations

Recommendation 1. Proceed with prescribing recipients under the Act, including the list of individuals and organizations appearing in Section 1 (Recipients) in the draft regulation.

Recommendation 2. Proceed with the definition of "transfer of value" as it appears in Section 2 (Transfer of value) of the draft regulation.

Recommendation 3. Make the reporting threshold for transfer of value $0.

Recommendation 4. Include in the public database under the Act all recipients of transfers of value who are deemed to be employees of payors, with the same identifying information on the recipient and the payor as is reported for payors and recipients who are not exempted from reporting.

Recommendation 5. Report in the public database all employment income received by recipients from payors.

Recommendation 6. Include a provision in the regulation requiring verification that drugs are given free of charge to patients.

Recommendation 7. Include in the regulation a requirement that all educational materials and items used in a clinical setting and donated by payors be clearly labeled so that users are aware of the donor's identity.

Recommendation 8. Include in the public database under the Act all recipients who are paid for expert testimony or other services with respect to a legal proceeding, with the same identifying information on the recipient and the payor as is reported for payors and recipients who are not exempted from reporting.

Recommendation 9. Do not exempt benefits provided by a drug manufacturer in accordance with ordinary commercial terms as set out in the regulations under the Ontario Drug Benefit Act. If these benefits are exempted, include in the public database under the Act all recipients of these transfers of value, with the same identifying information on the recipient and the payor as is reported for payors and recipients who are not exempted from reporting.

Recommendation 10. Report in the public database all payments to recipients for expert testimony or other services with respect to legal proceedings.

Recommendation 11. Proceed with prescribing pharmacies, laboratories and specimen collection centres as payors under the Act.

Recommendation 12. Proceed with the specification of reporting obligations on identification of businesses, identification of individuals, and transfers of value, as in section 7 of the draft regulation.

Recommendation 13. Proceed with the proposed timeline of Jan. 1, 2019 for the regulation and Act to come into force, and with annual reporting to start June 30, 2020 for 2019.

Recommendation 14. Ensure a reasonable process for recipients to review and correct information about transfers of value they are reported to have received, under the regulation.

About RNAO

The Registered Nurses' Association of Ontario (RNAO) is the professional association representing registered nurses (RN), nurse practitioners (NP), and nursing students in all settings and roles across Ontario. It is the strong, credible voice leading the nursing profession to influence and promote healthy public policy.

Resource Type: 
Submission