Bipartisan Medicare Care Coordination Act provides doctors flexibility
to participate in value-based payment models
Washington, D.C. – The Digestive Health Physicians Association (DHPA) applauds the proposal in President Trump’s FY 2019 Budget to establish new protections in the physician self-referral law (Stark Law) for health care services furnished through Alternative Payment Models (APMs). DHPA worked closely with Members in both chambers to develop bipartisan legislation that would do precisely what is called for in the President’s Budget.
The Medicare Care Coordination Improvement Act of 2017, (H.R. 4206, S. 2051) maintains the consumer protections that are the main tenets of the Stark Law, while providing doctors with the flexibility to improve care coordination through APMs. The legislation 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 also enable physician practices to incentivize doctors to provide high quality care while alternative payment models are under development and in operation.
“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 and the quality of care furnished to patients,” said Dr. Fred Rosenberg, president of DHPA. “Congress should pass the bipartisan Medicare Care Coordination Act, and eliminate the barriers created by the outdated Stark Law.”
While DHPA supports budget provisions to modernize the Stark Law, it also voiced opposition to a proposal in President Trump’s budget to establish a targeted prior authorization program for certain in-office ancillary services—a proposal that would undercut efforts to modernize the Stark Law.
“Any steps to limit the use of critical health care services such as advanced imaging, pathology and physical therapy services in independent physician practices will likely drive patients into the more expensive and less convenient hospital setting,” said Dr. Lawrence Kim, DHPA health policy chair. “The most recent Medicare physician claims data simply do not support the argument that physician self-referral encourages inappropriate utilization of services or increased spending. In fact, the data show that the services provided in independent physician practices help to lower costs.”
Research conducted by Milliman and commissioned by DHPA found that the utilization of anatomic pathology services in physician practices is a small percentage of total spending on ancillary services and is declining or growing more slowly than in hospital settings.
“DHPA looks forward to working with Congress and the Administration to support health care policies that promote accessible, high quality and cost-efficient patient care in the independent GI medical practice setting,” said Dr. Kim.
About the Digestive Health Physicians Association
The Digestive Health Physicians Association (DHPA) is a trade association comprised of 77 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 people in their medical groups.