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.
Modernizing the Stark Law
The Digestive Health Physician Association supports the bipartisan Medicare Care Coordination Improvement Act of 2017 (H.R. 4206, S. 2051), 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 24 physician organizations representing more than 500,000 physicians who care for millions of Medicare patients.
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.
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 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.
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.
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 […]