The head of Medicare testified that addressing restrictions designed to prevent fraud and abuse among physicians is ‘an important piece’ of the push for value-based healthcare delivery.
It remains unclear how high Stark Law reform ranks on the Trump administration’s list of healthcare policy priorities, but high-level officials keep mentioning it.
Demetrios Kousoukas, principal deputy administrator for the Centers for Medicare and Medicaid Services (CMS) and director of the Center for Medicare, said policymakers need to consider such reforms as they push toward a value-based healthcare system.
Kousoukas made the comments Wednesday in response to a question from Rep. Kenny Marchant, R-Texas, during a hearing on the implementation of physician payment policies under the Medicare Access and CHIP Reauthorization Act (MACRA).
“I have visited with some of the doctors in my district just recently and have heard from several of their physician organizations. Their big complaint is they say that the Stark laws are creating real barriers to their coordination,” Marchant said, before asking Kousoukas to help advance a bill that has the backing of a bipartisan group of nine representatives.
Virtual Workshop: Practical Training in Value-Based Care Delivery Under MACRA
Kousoukas responded by saying, generally, that the Trump administration is interested in solving the problem identified by the bill Marchant backs.
“It has a really big impact on how relationships are structured in the healthcare space,” Kousoukas said of the Stark laws, which prohibit physicians from referring a Medicare or Medicaid patient to a provider with which the physicians have financial ties.
“You have to look at all of the arrangements that are arrayed behind the physician that’s facing the patient and the complex web of financial and other relationships that come about partly as a result of the evolution of the healthcare system to have so many fractured silos to have so many rules and regulations that govern every part of the healthcare system,” Kousoukas said.
“We acknowledge that MACRA is just a piece of this, that we’ve got to look at the other parts,” he added, “and Stark is an important piece of that.”
Kousoukas pointed to the president’s budget proposal for fiscal year 2019, which includes a line item calling for the “physician self-referral law” to be reformed “to better support and align with alternative payment models [APM] and to address overutilization.”
The document does not include an estimate of how much such reforms would cost.
In making his comments, Kousoukas echoed CMS Administrator Seema Verma, who said during an American Hospital Association (AHA) webinar in January that “an inter-agency group” would conduct a Stark Law review.
The AHA has made its position on the matter clear. In a statement submitted to the health subcommittee of the House Ways and Means Committee for Wednesday’s hearing, the AHA referred to Stark and anti-kickback laws as “outdated.”
“These statutes and their complex regulatory framework are designed to keep hospitals and physicians apart—the antithesis of the new value-based delivery system models,” the AHA wrote, recommending that Congress create a “safe harbor” to promote collaboration in healthcare.
Steven Porter is an associate content manager and Strategy editor for HealthLeaders, a Simplify Compliance brand.