Perspective

Modernization of Stark Law promotes value-based care

Fred Rosenberg

The bipartisan legislation, “The Medicare Care Coordination Improvement Act of 2017,” was recently introduced by the Senate to modernize the Stark Law and eliminate the barriers it poses to care coordination.

A coalition of health care organizations, including the AMA, American Academy of Neurology, American College of Cardiology, American College of Gastroenterology and American College of Rheumatology, sent a letter to members of the Senate strongly supporting the bill.

“Your legislation would substantially improve care coordination for patients, improve health outcomes and restrain costs by allowing physicians to participate and succeed in alternative payment models,” they wrote.

Enacted nearly 30 years ago, the Stark Law hinders physician practices from participating in alternative payment models due to self-referral prohibitions, according to the coalition. The Stark Law also prohibits practices from rewarding or penalizing physicians for adhering to clinical guidelines and treatment pathways that aim to enhance patient outcomes and/or reduce costs and thus, suppressing care delivery, according to the organizations.

These restrictions were at odds with the value-based payment models established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Under the new legislation, CMS and HHS will have the regulatory authority to make exceptions within the Stark Law and associated fraud and abuse laws to allow for physician practice participation in alternative payment models.

In addition, the Medicare Care Coordination Improvement Act of 2017 will eliminate the prohibition of volume or value of referrals presented in the Stark Law to allow practices to incentivize physicians for carrying out best practices. The law will also guarantee that CMS promotes care coordination, quality improvement and resource conservation.

“We are at the dawn of a new delivery paradigm that can deliver improved patient outcomes and control costs,” the organizations wrote. “But that vision can only be achieved if antiquated laws based on dated treatment delivery schemes are modernized and physicians are allowed to succeed for their patients. Your legislation would do much to advance that vision into reality.”

The Digestive Health Physician Association (DHPA) also expressed its support of the new bill in the letter to the Senate.

Fred Rosenberg, MD, president of DHPA, told Healio Internal Medicine that, “DHPA is supportive of the legislation because the current Stark Law presents challenges to participating in the payment models incentivized in MACRA.”

He added, “These updates to the Stark Law are crucial if we are to realize Congress’ goal of shifting the Medicare program from a fee-for-service system to one that rewards care coordination, high-quality care and the efficient use of resources. Allowing physicians in independent medical practices to participate in alternative payment models and other value-based payment arrangements is critical to achieving the vision Congress set forth through MACRA.” – by Alaina Tedesco

Disclosure: Healio Internal Medicine was unable to confirm any relevant financial disclosures at the time of publication.

 

Fred Rosenberg

The bipartisan legislation, “The Medicare Care Coordination Improvement Act of 2017,” was recently introduced by the Senate to modernize the Stark Law and eliminate the barriers it poses to care coordination.

A coalition of health care organizations, including the AMA, American Academy of Neurology, American College of Cardiology, American College of Gastroenterology and American College of Rheumatology, sent a letter to members of the Senate strongly supporting the bill.

“Your legislation would substantially improve care coordination for patients, improve health outcomes and restrain costs by allowing physicians to participate and succeed in alternative payment models,” they wrote.

Enacted nearly 30 years ago, the Stark Law hinders physician practices from participating in alternative payment models due to self-referral prohibitions, according to the coalition. The Stark Law also prohibits practices from rewarding or penalizing physicians for adhering to clinical guidelines and treatment pathways that aim to enhance patient outcomes and/or reduce costs and thus, suppressing care delivery, according to the organizations.

These restrictions were at odds with the value-based payment models established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Under the new legislation, CMS and HHS will have the regulatory authority to make exceptions within the Stark Law and associated fraud and abuse laws to allow for physician practice participation in alternative payment models.

In addition, the Medicare Care Coordination Improvement Act of 2017 will eliminate the prohibition of volume or value of referrals presented in the Stark Law to allow practices to incentivize physicians for carrying out best practices. The law will also guarantee that CMS promotes care coordination, quality improvement and resource conservation.

“We are at the dawn of a new delivery paradigm that can deliver improved patient outcomes and control costs,” the organizations wrote. “But that vision can only be achieved if antiquated laws based on dated treatment delivery schemes are modernized and physicians are allowed to succeed for their patients. Your legislation would do much to advance that vision into reality.”

The Digestive Health Physician Association (DHPA) also expressed its support of the new bill in the letter to the Senate.

Fred Rosenberg, MD, president of DHPA, told Healio Internal Medicine that, “DHPA is supportive of the legislation because the current Stark Law presents challenges to participating in the payment models incentivized in MACRA.”

He added, “These updates to the Stark Law are crucial if we are to realize Congress’ goal of shifting the Medicare program from a fee-for-service system to one that rewards care coordination, high-quality care and the efficient use of resources. Allowing physicians in independent medical practices to participate in alternative payment models and other value-based payment arrangements is critical to achieving the vision Congress set forth through MACRA.” – by Alaina Tedesco

Disclosure: Healio Internal Medicine was unable to confirm any relevant financial disclosures at the time of publication.

    Perspective

    “The Medicare Care Coordination Improvement Act of 2017” will give CMS the tools that it needs to design a full range of physician-focused alternative payment models. The bill promotes care coordination and will enable physicians to participate more fully in the value-based payment models incentivized by MACRA.

    Under the MACRA legislation, physicians have a choice — they can participate in the default program — the Merit-Based Incentive Payment System (MIPS), or they can participate in an advanced alternative payment model, which emphasizes care redesign, care coordination, higher quality care through quality metrics and improved efficiency (lower costs). MACRA provides financial incentives for physician participation in advanced alternative payment models. Thus far, CMS has launched some advanced alternative payment models that have been mostly for primary care physicians.

    The provisions in this bill will give CMS the tools to be able to design advanced alternative payment models with financial incentives (without the associated legal jeopardy) that involve specialists in addition to primary care physicians collaborating on care coordination and care redesign. Such models could include more complex chronic disease with potentially longer episode periods.

    • John McInnes, MD, JD
    • Counsel, Arnold & Porter Kaye Scholer LLP

    Disclosures: McInnes reports no relevant financial disclosures.

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