The time period has closed for submitting comments to the Centers for Medicare and Medicaid Services (CMS), which had issued a request for information regarding the physician self-referral law section 1877 of the Social Security Act (known as the Stark Law) enacted in 1989. Potential changes to the Stark Law could have significant effects on the health care industry. The changing landscape of health care requires us to reconsider the antiquated laws limiting the health care field’s progress into the 21st century.
The purpose of the request, as stated by the Department of Health and Human Services (HHS), is “working to transform the healthcare system into one that pays for value. Care coordination is a key aspect of systems that deliver value. Removing unnecessary government obstacles to care coordination is a key priority for HHS. To help accelerate the transformation to a value-based system that includes care coordination, HHS has launched a Regulatory Sprint to Coordinated Care, led by the Deputy Secretary. This Regulatory Sprint is focused on identifying regulatory requirements or prohibitions that may act as barriers to coordinated care, assessing whether those regulatory provisions are unnecessary obstacles to coordinated care, and issuing guidance or revising regulations to address such obstacles and, as appropriate, encouraging and incentivizing coordinated care.”1
The American Podiatric Medical Association (APMA) submitted comments to CMS with two requests.2
- Modernize and simplify regulatory burdens so all physicians can more readily participate in new practice models that come with complex financial arrangements; and
- Provide patients direct access to data sources on price transparency and quality of services provided so those patients have a clearer picture of the value of care being recommended by the physician, regardless of financial ownership stakes.
The emerging paradigm shift in health care with physicians facing declining reimbursement and escalating costs, ancillary sources of income have become the norm rather than the exception. Physician-owned surgery centers, outpatient vascular labs, imaging centers, physical therapy centers, pathology laboratories, et cetera, exist, but the regulatory governmental oversight on these collaborations are unduly and burdensome, stifling this paradigm shift.
The patient component of this is critical to understand. Pricing transparency and quality of care should be equally important in health care as it is in any consumer transaction.
The American Hospital Association (AHA) supports changes to the Stark Law. In prior testimony to the Subcommittee on Health of the Ways and Means Committee of the House of Representatives, the AHA stated “Congress should create a clear and comprehensive safe harbor under the anti-kickback law for arrangements designed to foster collaboration in the delivery of health care and incentivize and reward efficiencies and improvement in care. In addition, the Stark Law should be reformed to focus exclusively on ownership arrangements. Compensation arrangements should be subject to oversight solely under the anti-kickback law.”3
The CMS proposed 20 open-ended questions for stakeholders to consider in responding to the request for information. These questions provide some insight on potential changes to the Stark Law. All physicians should pay close attention to CMS’s potential modification of the Stark Law. The law written almost 30 years ago is outdated. The key stakeholders in health care (providers and patients alike) deserve a law that progresses health care change instead of holding us back.
- Medicare program; request for information regarding the physician self-referral law. Federal Register. Available at https://www.federalregister.gov/documents/2018/06/25/2018-13529/medicare-program-request-for-information-regarding-the-physician-self-referral-law
- APMA submits comments to CMS on Stark RFI. Available at https://www.apma.org/News/NewsDetail.cfm?ItemNumber=31035
- Statement of the American Hospital Association before the Subcommittee on Health of the Committee on Ways and Means of the U.S. House of Representatives. Available at https://www.aha.org/system/files/2018-03/180321-macra-statement-house-ways-means.pdf