CMS Requesting Public Comment on Stark Law Changes

CMS Administrator Seema Verma said Wednesday the agency is seeking public comment on the so-called Stark Law, which was enacted to prevent independent physicians from referring Medicare patients to facilities where they have a financial benefit.

The agency said it was focusing, among other things, on how the law may impede care coordination.

“To achieve a truly value-based, patient-centered health care system, doctors and other providers need to work together with patients. Many of the recent statutory and regulatory changes to payment models are intended to help incentivize value based care and drive the Medicare system to greater value and quality,” wrote CMS chief Seema Verma on her blog.

CMS said it is particularly interested in comments regarding the structure of arrangements between provviders and entities that participate in alternative payment models (APM) or other financial arrangements, the need for revisions or additions to exceptions to the Stark Law, and related terminology.

Public comments are due by August 24, 2018.

The Stark Law is formally known as the Ethics in Patient Referrals Act, but is more commonly known as the Stark Law for its author, then-US Rep. Fortney “Pete” Stark (D-California). The law was passed in 1989 and expanded in the 1990s, and was further accompanied by rules and regulations that doctors say are limiting their ability to advance in a healthcare system that prioritizes advanced alternative payment models that incentivize care coordination.

Writing in The American Journal of Managed Care^® (AJMC^®) last year, gastroenterologist Lawrence Kim, MD, said the law presents "serious challenges for independent physicians." He cited the shift from fee-for-service (FFS) delivery systems to APMs. Using colon cancer screening as an example, he envisioned a care coordination model that brings together primary care physicians, gastroenterologists, radiologists, pathologists and anesthesiologists, who often work in separate medical practices.

However, without changes to the Stark Law, the following is prohibited, he wrote: primary care physicians working to ensure that appropriate patients are referred to gastroenterologists, who in turn coordinate with anesthesiologists to assess patient risk profiles and determine which patients should have their screening colonoscopy done in a free-standing ambulatory surgery center rather than in a hospital.

"The success of independent physician practices is crucial to lowering healthcare costs, and failure to improve care coordination could drive patients into the more expensive hospital setting," Kim wrote.