On Oct. 28, the American Association of Orthopaedic Surgeons joined other national and state physician organizations in signing a letter to Health and Human Services Secretary Kathleen Sebelius expressing “serious concerns” about a key part of the Physician Payments Sunshine Act. The more than 70 physician-organization signatories argued that medical textbooks, reprints of peer-reviewed scientific journal articles, and abstracts should be excluded from the restrictions because these items directly benefit patients, although they may not be intended for direct use by patients. The Oct. 28 letter, which was spearheaded by the AMA and the Massachusetts Medical Society, says that the decision by the Centers for Medicare & Medicaid Services to not include these educational materials as exclusions in the regulation is “contrary to both the statute and congressional intent and will potentially harm patient care by impeding ongoing efforts to improve the quality of care through timely medical education.” The letter goes on to say that these items are “essential tools” that doctors use to stay informed of the latest developments. The letter further states that including these items in the Sunshine Act reduces the focus on quality patient care.