As our healthcare system shifts from a fee-for-service model to value-based care, two payment structures incentivized by the Medicare Access and CHIP Reauthorization Act (MACRA) are the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).
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Modernizing the Stark Law
The Digestive Health Physicians Association supports the bipartisan Medicare Care Coordination Improvement Act of 2019 (H.R 2282, S. 966), which promotes care coordination and will enable physicians to participate more fully in the value-based payment models incentivized by the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
The legislation has the full support of 27 physician organizations representing more than 500,000 physicians who care for millions of Medicare patients.
The Medicare Care Coordination Improvement Act would modernize the outdated “Stark” self-referral law that poses barriers to care coordination. Congress recognized the Stark Law hinders care coordination when it authorized the Secretary at the Department of Health and Human Services (HHS) to waive the self-referral and anti-kickback prohibitions for Accountable Care Organizations. MACRA’s full potential can only be achieved by modernizing this law for physician-led alternative payment models (APMs) as well.
The bill will provide CMS with the regulatory authority to create exceptions under the Stark Law for APMs and to remove barriers in the current law to the development and operation of such arrangements.
Policy Recommendations for Modernizing the Stark Law
The physician self-referral law, know as the “Stark Law,” was passed by Congress in 1989 and substantially amended in 1993. Health care delivery has changed dramatically since then, but this antiquated state has not kept pace with new and innovative delivery models.
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Twenty-Two Leading Physician Organizations Join Forces to Propose Stark Law Reforms
The Digestive Health Physicians Association (DHPA) joined 21 other leading physician organizations in sending a letter to the U.S. Senate Committee on Finance and the U.S. House Committee on Ways and Means with policy recommendations for modernizing the Stark Law.
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DHPA Plays Leadership Role in Shaping Stark Law Reform
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.
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Medicare Anatomic Pathology Utilization: 2009 Through 2013
In June 2013, the U.S. Government Accountability Office (GAO) published a report, “Medicare Action Needed to Address Higher Use of Anatomic Pathology Services by Providers Who Self-Refer” (GAO Report), which discussed the utilization of anatomic pathology (AP) services in the fee-for-service (FFS) Medicare program. The GAO Report focused on the growth of AP services between calendar years 2004 […]
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