Stark Law modifications
Dr. Kapoor explained that LUGPA is supporting the Medicare Care Coordination Improvement Act of 2017, which would provide CMS the regulatory authority to create exceptions under the Stark Law for alternative payment models (APMs) and remove barriers in current law to the development and operation of such arrangements.
He pointed out that physician practices are hampered from fully and successfully participating in APMs because of 30-year-old self-referral prohibitions that pose a barrier to care coordination.
“I’ve been working closely with the bill’s sponsors in both the House and Senate,” Dr. Kapoor said. “Stark was designed for fee-for-service, not value-based care. If I am assuming risk for performance of a service and not paid on a fee-for-service basis, there is no incentive for me because the law prohibits us from gainsharing arrangements when it comes to volume or value.”
Dr. Kapoor said Stark prohibitions “stifle care delivery innovation by inhibiting practices from incentivizing their physicians to deliver patient care more effectively and efficiently because they cannot use resources from designated health services, such as pathology, advanced imaging, radiation therapy, and physical therapy in rewarding or penalizing adherence to clinical guidelines and treatment pathways.”
The legislation was introduced with bipartisan sponsorship in both the House and Senate in early October 2017. Dr. Kapoor said it is supported by more than 25 physician and other provider organizations representing more than 500,000 clinicians.
“We’ve been working hard on the legislation sponsored by Reps. Marsha Blackburn (R-TN) and Bobby Rush (D-IL) to reform the U.S. Preventive Services Task Force, which has issued restrictive recommendations on the PSA test for prostate screening, among other controversial clinical recommendations," Dr. Kapoor said.
He pointed out that support for the USPSTF Transparency and Accountability Act has been building in Congress since it was first introduced in 2015. The measure would require that a “balanced representation of primary and specialty care providers” and other key stakeholders be involved in the development and review of USPSTF recommendations.
“Hopefully, we’ll have some good news to report soon,” said Dr. Kapoor. “This bill is finally getting traction. We’re working on securing a sponsor in the Senate, and we should have that nailed down soon.”
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