DHPA submitted comments in response to a Request for Information (RFI) from the Office of Inspector General (OIG) in the U.S. Department of Health and Human Services regarding the need to modernize the Anti-Kickback Statute. DHPA’s comment letter complements another set of comments submitted to CMS which focused on modernizing the Stark law to remove barriers to care coordination in a value-based payment system.
As OIG noted in its RFI, there is a clear intersection between the Stark law and Anti-Kickback Statute when it comes to addressing barriers to care coordination in a value-based payment system. OIG (much like CMS) asked for concrete examples of the types of alternative payment models (APMs) and other novel financial arrangements that physician practices are trying to develop for the benefit of Medicare beneficiaries and other patients.
DHPA’s letter shared two examples that DHPA member practices were instrumental in developing – Project Sonar and the Colonoscopy Advanced APM – that have been blocked from use with Medicare beneficiaries because of challenges with the Anti-Kickback Statute and Stark law. These laws were created decades ago in a fee-for-service payment system that did not contemplate the type of care coordination and sharing of resources across health care entities that are so critical to success in a value-based payment system.
DHPA asked OIG to take the following steps to ensure that value-based payment arrangements work well for all physicians, including GI physicians who care for patients in the independent practice setting:
- Exercise existing regulatory authority to create a comprehensive waiver of the Anti-Kickback Statute for participants in bona fide APMs so that independent gastroenterology (and other specialty) practices can participate in a full complement of APMs.
- Create a new safe harbor under the Anti-Kickback Statute to encourage development and operation of APMs and other value-based care delivery models.
- Support passage of the bipartisan Medicare Care Coordination Improvement Act (S. 2051, H.R. 4206) as a mechanism for making those changes to health care fraud and abuse laws that cannot be achieved through regulation.
Click here to read the full comment letter.