HHS Proposes Stark Law and Anti-Kickback Statute Reforms to Support Value-Based and Coordinated Care

The main goal of all healthcare initiatives, regardless of the sector endorsing them, should be to improve patient care. Improving patient care incorporates increasing access, enhancing quality, and reducing costs. In recent years, the healthcare industry has taken positive steps to improving care by promoting a system based on quality over quantity. In this value-based system, providers are paid based on patient outcomes rather than on volume of procedures performed. This model intends to focus on preventative, personalized medicine, and improving overall patient wellness, thereby increasing patient satisfaction and general population health. It also will reduce costs for both patients and providers. Although there are many benefits to the value-based system, and although the healthcare industry is working toward this model, government regulations are obstructing complete reform.


The U.S. Department of Health and Human Services (HHS) believes that the Stark Law and Federal Anti-Kickback Statute include policies that prevent the value-based model from moving forward. The Stark Law prohibits physicians from referring patients for certain services paid by Medicare or Medicaid to an entity in which they have a financial relationship. The Anti-Kickback Statute prohibits the exchange of anything of value for referrals for services that are payable by a federal program.


On Wednesday, October 9th, HHS proposed changes to both laws that would better clarify and define their regulations for physicians to fully understand how to participate in value-based arrangements while staying compliant with the laws. The modifications would also protect patients and programs from fraud and abuse. The primary goal of these efforts is to better coordinate care for patients by allowing providers to work together.


Under the proposed rule, the Stark Law would continue to protect against overutilization, but would also make clear that incentives are different in a system that pays for value. For example, outcome-based payment arrangements that reward improvements in patient health would be acceptable. The changes would allow more flexibility for providers and better coordinated care. Patient information sharing would be both allowed and more secure, such as with a primary care physician and a specialty physician. Data analytics systems would be used to better manage patient care between a hospital and physician. These are just some examples of the positive outcomes that could result from the proposed changes.


Ultimately, the HHS’ recommended alterations to the Stark Law and Anti-kickback statute will improve patient care and overall health outcomes using data-sharing, analytics, patient engagement activities, and permitted physician communication.


To learn more about the suggested changes to these laws, read the article at the following link: https://www.hhs.gov/about/news/2019/10/09/hhs-proposes-stark-law-anti-kickback-statute-reforms.html


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