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HIMSS: Stark Law Hinders Care Coordination, Health Data Exchange

HIMSS urged CMS to reduce the administrative burdens of the Stark Law and ensure the rule supports care coordination among providers.

HIMSS recommended CMS change Stark Law to support care coordination and health data exchange.

Source: Thinkstock

By Kate Monica

- The Physician Self-Referral Law, commonly known as the Stark Law, places unnecessary administrative burdens on providers while hindering care coordination and health data exchange, according to a letter from HIMSS to CMS Administrator Seema Verma.

In response to the federal agency’s June request for information (RFI), HIMSS advised CMS to change Stark Law regulations to ensure they do not prohibit or interfere with health data exchange and care coordination.In its letter, HIMSS emphasized that alternative payment models (APMs) require a flexible regulatory framework to succeed.

“HIMSS believes that APMs would be better served if CMS allowed more physician self-referral law waivers for APMs, similar to the waivers offered in many of the innovation models currently being piloted by CMS,” the letter stated.

“For example, the Medicare Shared Savings Program (MSSP) incentivizes providers to improve quality and reduce cost, as well as resource utilization, which are efforts that require coordination in ways that would likely not occur in a typical fee-for-service relationship.”

HIMSS recommended CMS use its waiver authority to allow APMs to prioritize patient access to care.

“This waiver authority should be designed without a focus on the potential financial implications of any referrals for providers, and be aligned across all CMS programs, including in the testing of new and innovative payment and service delivery models,” HIMSS maintained.

Allowing more waivers for physicians in APMs will help to significantly reduce administrative burden on providers.

Stark Law waivers will also help to support health data exchange among providers in APMs, HIMSS asserted. Self-referral laws in their current form limit the flow of information across organizations.

“To share information, it is often necessary to implement, use and maintain costly tools that not all providers can readily afford, including access to multiple interoperability exchanges, networks, and approaches to share data across the care continuum,” wrote HIMSS.

“HIMSS recommends that the physician self-referral regulations be changed so as to no longer prohibit any data sharing scenario that aggregates, normalizes, or secures patient data in connection with the coordination of care for a patient,” the society continued.

CMS should craft Stark Law policies to support the aims of the MyHealthEData initiative, HIMSS suggested.

Lead by the White House Office of American Innovation, MyHealthEData is geared toward giving patients more control over their own EHR data by breaking down existing barriers to health data access and use.

The regulatory burdens and reporting requirements associated with Stark Law deter physicians from engaging in health data exchange with some outside providers, says HIMSS.

Stark Law in its current form also negatively affects care quality, the letter added.

“HIMSS members state that, due to the physician self-referral regulation provisions — and its focus on where a patient is referred rather than what is the most appropriate level of care for that patient at that time — patients are often referred to a lower level setting of care because of complexities around potential financial relationships between providers,” wrote HIMSS.

HIMSS suggested future Stark Law regulations support transparent discussions between patients and providers about referrals. Providers should explain the benefits and drawbacks of potential care settings using data from CMS quality rating programs.

“As care delivery has evolved from fee-for-service to a value-based care model, we encourage CMS to undertake an expansive evolution of the physician self-referral regulation to support further development of APMs and broader healthcare transformation efforts,” stated HIMSS.

In addition to highlighting the unnecessary administrative burden associated with Stark Law, HIMSS also noted the regulations inhibit provider access to cybersecurity services.

“We would be happy to convene our volunteers with CMS officials to share specific experiences and recommendations as they relate to the physician self-referral law,” concluded HIMSS.

The public comment period for stakeholders to submit feedback about potential Stark Law changes closed August 24.



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