Act II of the Sunshine Act nails the necessary dynamic if the Act is to achieve its desired effects. There are clear winners and losers in this regard. The organizations and stakeholders who benefit from payments to influence their decisions will lose and have every incentive to undermine or game the new system. Health care consumers and their advocates with little or no money to spread around will be the winners.

The recent Center for Medicare and Medicare Services (CMMS) rule change to indirect payments to physicians who provide industry-funded continuing medical education (CME) expands opportunities to game the system. See: https://s3.amazonaws.com/....

Now it will be up to CME programs to lead the way (if they have commitment and guts) by inquiring before engaging physicians about the extent of industry payments they are receiving. CME programs have an obligation to students to vet their teachers for potential direct or indirect industry influence. CME students have an obligation to demand that they do. The CMMS could easily require organizations that provide CME to certify, subject to random audits and penalties, having put in place and implemented such a low-cost conflict-of-interest oversight program.

If the CMMS fails to use its authority to build the necessary supports for achieving the intent of the Sunshine Act, it will signal the real position of the Obama and succeeding administrations.