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    Bill would lift Stark barriers to APMs

    Legislation would help with care coordination, supporters say


    ‘A critical milestone’

    “The introduction of Stark modernization legislation is a critical milestone in our efforts to improve the ability of independent practices to deliver quality, accessible care,” said LUGPA President Neal D. Shore, MD.

    “Large health systems were granted waivers from Stark laws to establish ACOs years ago, but those protections were not extended to physicians in independent practice, which excluded the most cost-effective site of service from participating in value-based care models,” Dr. Shore said. “This legislation is an important step in the right direction to leveling the playing field and allowing patients the ability to access high-quality care at the location of their choosing.”

    Read: Senate takes aim at pharmacy benefit managers’ role in rising drug costs

    Key provisions of the legislation would:

    • provide CMS the same authority to waive prohibitions in the Stark Law and anti-kickback statute for physicians seeking to develop and operate APMs as was provided to ACOs in the ACA
    • remove the “volume or value” prohibition in the Stark Law for physician practices that are developing or operating APMs, allowing them to align incentives for their physicians to abide by best practices and succeed in the new value-based APMs
    • ensure that CMS’s use of its current administrative authority promotes care coordination, quality improvement, and resource conservation.

    LUGPA Health Policy Chair Deepak A. Kapoor, MD, said the 30-year-old Stark Law self-referral prohibitions effectively block coordination of care by physicians.

    “I’ve been working closely with the bill’s sponsors in both the House and Senate,” he told Urology Times. “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.”

    Further, 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.”

    Also see: Statewide tests on the role of MOC multiply

    Introduction of the legislation—particularly with bipartisan sponsorship in both chambers of Congress—is an important step, but the road to final passage is a long and bumpy one. However, the new bill is now before lawmakers for consideration and perhaps could find its way to passage as an amendment to broader health-related legislation.

    Next: House approves IPAB repeal

    Bob Gatty
    Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.


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