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AHA Seeks Changes to Stark Law to Support Care Coordination

AHA urged policymakers to revise and update Stark Law to better support care coordination and value-based care.

Stark Law needs to be revised to support care coordination during the transition to value-based care.

Source: Thinkstock

By Kate Monica

Stark Law in its current form impedes care coordination and limits physicians’ ability to transition to a value-based care system, according to AHA President and CEO Rick Pollack.

Pollack emphasized the need for legislators and regulators to update and revise Stark Law — or physician self-referral law — to better support care coordination in a recent AHA blog post.

“It’s been well established that the health care system is moving from a fee-for-service world to one where payers reward value over volume,” wrote Pollack.  “This requires care coordination and providers across the health care continuum working together to achieve the best outcomes for patients.”

Outdated physician self-referral laws designed in a fee-for-service healthcare system hold physicians back from collaborating across the care continuum to improve patient health outcomes.

“Working with our members, we’ve collected examples and outlined how the physician self-referral, or ‘Stark’ law impedes coordination and shared concrete recommendations for modernizing the law with legislators and regulators,” stated Pollack.

Pollack stated he was encouraged by the consensus building among legislators and regulators at the House Ways & Means Committee Health Subcommittee that Stark Law needs to be redesigned to better suit a value-based care environment.

HHS Deputy Secretary Eric Hargan acknowledged at the committee meeting that the law is no longer fulfilling its intended purpose. House Ways & Means Committee Health Subcommittee Chair Peter Roskam (R-IL) similarly supported the push to update Stark Law.

Roskam has been working with stakeholders such as AHA to identify which areas of Stark Law most need to be revised.

“The goal here is shared by all,” said Roskam during the subcommittee hearing. “Better care for Medicare patients.”

Senate Finance Committee Chair Orrin Hatch (R-UT) also stated during the hearing that the law “presents practical and outdated barriers in need of updating, while former HHS Secretaries Kathleen Sebelius and Tommy Thompson urged swift legislative action.

“Over time, many regulations were adopted and designed to prevent fraud and abuse — a worthy goal,” said Thompson. “But many regulations, designed for a fee-for-service model, now create roadblocks in the move toward a value-based system and need to be modernized.”

Ultimately, Pollack urged HHS to create a new payment exception in Stark Law for value-based payment arrangements.

“Creating this exception would present hospitals with a new opportunity to implement incentives that drive physician decision-making toward high-value care for each and every patient they see,” stated Pollack.

AHA recommended the exception protect value-based incentive programs that promote accountability for the quality, cost, and overall care of patients. The exception should also promote care management and care coordination, as well as investments in health IT infrastructure and redesigned care processes for high quality care delivery.

“Health care delivery is changing, and the regulations that govern it need to keep pace,” stated Pollack. “To truly realize the promise of value-based care for patients, we need action. We’re pleased to see stakeholders working to come to consensus on changes to Stark and stand ready to help move forward.”

CMS recently issued a Request for Information (RFI) seeking public comment and recommendations about how to reduce regulatory burden associated with Stark Law.

Responses to the RFI will help HHS better understand provider concerns surrounding specific regulations related to Stark Law and enable more targeted burden reduction efforts.

“We are looking for information and bold ideas on how to change the existing regulations to reduce provider burden and put patients in the driver’s seat,” said CMS Administrator Seema Verma.

Stakeholders have until August 24, 2018 to submit feedback to CMS.

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