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.
Modernizing the Stark Law
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).
MIPS is a modified fee-for-service system in which a portion of physician payments will be based on quality, resource use across the entire Medicare program, meaningful use of electronic health records, and clinical practice improvements. APMs are arrangements like an Accountable Care Organization or bundled payment model that requires physicians to take on risk and bases compensation on quality. As such, physicians will need to coordinate care, control volume and work as teams.
The outdated Stark Law makes it difficult for independent GI practices to engage in APMs or MIPS and should be modernized to provide clarity and flexibility for participation in value-based payment models.
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 […]