Physicians and hospital groups want to see exceptions to the enforcement of the physician self-referral or Stark Law, in order to reduce barriers to value-based payment models.
Concerned the law may stand in the way of the move to value-based care and APMs, CMS sought ideas on how to reduce the regulatory burdens of the physician self-referral law, especially as it relates to fielding Medicare pay-for-performance models of care, particularly Accountable Care Organizations (ACOs).
In response to CMS’ request for information on potential changes to the enforcement of the physician self-referral or Stark Law, the AMGA said changes to the timing and availability of Stark law waivers, how the law should be applied to alternative payment models (APMs), and how transparency can better inform Medicare beneficiaries’ decision-making would make a difference.
Concurring with concerns about the Stark law, the American Hospital Association sent a letter (PDF) recommending a new exception for value-based payment arrangements and modifications to the personal services and risk sharing exceptions. However, the organization urged the government to not make any changes to the regulations implementing the Stark Law’s ownership ban.
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The Stark law prohibits physicians from referring patients to other providers with whom they have a financial relationship. As it is written, government officials say the law may prohibit some relationships designed to enhance care coordination, improve quality and reduce waste.
“The intent behind the Stark law, as Congressman Pete Stark himself admitted, was to create bright-line rules so physicians can police their own behavior and not get distracted from focusing on improving care delivery,” said Jerry Penso, M.D., AMGA president and CEO. The trade association is helping lead the drive to value-based care.
“New innovative models of care present a challenge for regulators who want to improve care coordination and outcomes via incentivized value-based arrangements without creating legal uncertainty in advancing these goals. CMS is in a difficult position, but there are regulatory improvements, however incremental, that can be made to Stark,” Penso said.
In a letter (PDF) to HHS Secretary Alex Azar, the AMGA recommended CMS provide the time and flexibility needed to amend changes in practice patterns that were implemented as part of participation in an ACO. Rather than end waiver authority immediately upon an exit from the model, CMS should provide healthcare providers with additional time to come into compliance and should keep waivers in place if they participate in other, non-Medicare APM models that include Medicaid and/or commercial plans.