At the request of the U.S. Senate Committee on Finance and the U.S. House Committee on Ways and Means, DHPA submitted comments on ways to modernize the Stark Law. On behalf of the more than 1,300 gastroenterologists and other GI specialists in our 58 member practices, DHPA outlined ways in which the Stark Law conflicts with Congress’s goals in enacting the recently passed Medicare Access and CHIP Reauthorization Act (MACRA), as well as particular provisions of the current Stark Law that inhibit independent GI and other physician specialty practices from participating in new payment models.
DHPA also proposed several legislative changes to the Stark Law that would modernize the statute consistent with MACRA and provide physicians in independent medical practices with the flexibility and clarity to participate in value-based payment models. To that end, DHPA provided the following policy recommendations to guide the committees as they consider reforms to the Stark Law:
- The unlevel playing field that provides flexibility to hospital led care, but not to physician led care must be addressed. The current standards to determine whether an entity is a “group practice” create significant compliance risk for independent practices that undermines competition and fuels the acquisition of physician practices by large hospital systems. This definition needs to be modified to allow greater care coordination between physicians.
- Congress needs to clarify that “fair market value” was not intended to limit incentive-based compensation. CMS has greatly expanded Congress’s definition of “fair market value,” which threatens the ability of independent practices to participate in incentive-based compensation arrangements.
- Stark Law reform must be consistent with MACRA’s aim of encouraging providers to adopt Alternative Payment Models (APM). Currently, private pay ACO arrangements may raise compliance risks under the Stark Law. To mitigate the risks associated with adoption of an APM, reforms should expand protections for ACOs (which are currently primarily hospital-based) to independent practices in value-based arrangements.
- Provide CMS more flexibility to create Stark Law exceptions that will support implementation of MACRA. Congress placed responsibility on CMS to implement MACRA, yet numerous unforeseen decisions will be required to optimize its implementation. Under current law, CMS can only craft new Stark Law exceptions if it can guarantee that exceptions “do not pose a risk of patient or program abuse.” This significantly limits the ability of CMS to make exceptions as needed, in turn contributing to overly restrictive policies being placed upon independent physician practices.
Click here for the full comment letter on modernizing the Stark Law.