Stark Law modernization will allow physicians in independent practices to participate in new
value-based payment models that will improve quality and outcomes for Medicare patients
Washington, D.C. – The Digestive Health Physicians Association (DHPA) applauds today’s introduction of bipartisan, bicameral federal legislation to promote care coordination for Medicare patients and enable physicians to participate more fully in the value-based payment models Congress envisioned when it enacted the bipartisan Medicare Access and CHIP Reauthorization Act (MACRA) in 2015.
“The Medicare Care Coordination Improvement Act of 2017,” H.R. 4206, was introduced in the U.S. House of Representatives by Rep. Larry Bucshon (R-IN), Rep. Raul Ruiz (D-CA), Rep. Kenny Marchant (R-TX) and Rep. Ron Kind (D-WI). A companion bill, S. 2051, was introduced in the U.S. Senate by Sen. Rob Portman (R-OH) and Sen. Michael Bennet (D-CO). The legislation seeks to eliminate barriers created by the federal physician self-referral prohibitions (Stark Law), which currently inhibit physician practices that are developing advanced alternative payment models (APMs) from rewarding or penalizing physicians for complying with clinical guidelines and treatment pathways designed to improve patient outcomes and/or lower costs with revenue from designated health services.
“Certain aspects of the Stark Law, which were enacted almost 30 years ago, impose restrictions on coordinated care that are fundamentally at odds with the value-based payment system that Congress established through MACRA,” said Dr. Fred Rosenberg, president and chairman of the board of directors of DHPA. “Modernizing the Stark Law to allow physicians in independent medical practices to participate in Alternative Payment Models and other value-based payment arrangements is critical to enhancing the accessibility, quality, and cost efficiency of care for Medicare patients.”
The Medicare Care Coordination Improvement Act would remove barriers to physician practice participation in APMs. Specifically, it would provide the U.S. Department of Health and Human Services the same authority to waive restrictions in the Stark Law and Anti-Kickback Statute for physicians seeking to develop and operate APMs, as was provided to Accountable Care Organizations in the Affordable Care Act. It would allow physician practices to incentivize practitioners to provide high quality care while alternative payment models are under development and in operation.
The bipartisan legislation is supported by DHPA and 23 physician organizations whose member physicians care for millions of Medicare patients – in the fields of cardiology, dermatology, gastroenterology, neurology, oncology, ophthalmology, orthopedic surgery, urology, and others – but face challenges to participating in the payment models incentivized in MACRA. The physician groups have joined together to sign letters of support for the legislation in the U.S. House and the U.S. Senate.
“These updates to the Stark Law are crucial if we are to realize Congress’ goal of shifting the Medicare program from a fee-for-service payment system to a structure that rewards care coordination, high-quality care and the efficient use of resources,” said Dr. Lawrence Kim, chair of health policy for DHPA. “We salute this bipartisan effort and we look forward to working with Congress to pass this critical legislation in the coming months.”
About the Digestive Health Physicians Association
The Digestive Health Physicians Association (DHPA) is a trade association comprised of 75 independent gastroenterology (GI) physician practices in 36 States across the country with the aim of promoting and preserving accessible, high quality and cost-efficient care in the independent GI medical practice setting. DHPA’s member practices include more than 1,800 gastroenterologists and other physician specialists who provide care for approximately 2.5 million people annually. DHPA member practices employ more than 11,000 employees in their medical groups.