Congressional action on Stark Law is critical to developing value-based healthcare

Nearly 30 years ago, Congress enacted legislation known as “Stark Law” that set very specific limits prohibiting physicians like myself from referring patients for tests and services to certain healthcare facilities. Over time, it has become widely recognized that the nation’s healthcare needs are better served by a transition to “value-based healthcare,” which incentivizes providers to improve outcomes while controlling costs. However, achieving this model has been challenging due to Stark Law regulations. Congress recognized that Stark Law creates barriers to value-based healthcare models and thus granted exceptions to hospitals, but unfortunately, did not extend these same waivers to integrated, independent physician practices.

Last week, The Centers for Medicare & Medicaid Services (CMS) issued a request for public comment on how to address the regulatory impact and burden of Stark Law. This follows on the heels of a CMS announcement of the formation of an interagency group tasked with reviewing the barriers created by Stark Law in order to aid physicians in the transition to value-based care. While these actions will help level the playing field among healthcare providers, in order to address the issues that negatively impact physicians and patients affected by Stark Law barriers, Congress must pass corrective legislation.

Promoting a value-based healthcare system requires the development and implementation of alternative payment models (APMs), which emphasize care models where physicians assume greater financial responsibility for advancing patient outcomes. Stark Law prevents independent practices like mine from sharing services with other practices or even institutions, creating insurmountable advantages for monopolized hospital systems. These obstacles continue to delay the transition to value based care, thereby increasing costs for patients.

It is for these reasons that I’m urging Members of U.S. House of Representatives and the U.S. Senate to support the Medicare Care Coordination Improvement Act (MCCIA). This legislation, introduced with bipartisan support in both the United States Senate and House of Representatives, removes regulatory barriers to value-based care delivery by physician practices. It will grant physicians in independent practices the ability to develop and test novel payment paradigms in value-based care models and provide care under ACO-like waivers. Large health systems have been granted waivers from Stark Laws, but these waivers and protections were not extended to physicians in independent practices. This must be corrected.

The proposed MCCIA legislation will also encourage physicians to integrate value-based care into their patient encounters. By properly incentivizing practices to operate in alignment with a value-based system, quality care coordination will be rewarded, costs will be reduced, and patients will benefit.

The Medicare Care Coordination Improvement Act is vital to ongoing healthcare reform for physicians across all independent practices. Stark Law modernization is a critical milestone in efforts to level the playing field between independent practices and large healthcare systems, while also granting patients the ability to access high-quality care at a location of their choosing. For too long, physicians have been working within an outdated system that serves neither the patient nor the provider. It is time to support new laws that promote quality, value-based care and properly incentivize physicians through Medicare reform.

As a urologist who has advocated on behalf of independent physicians for years, I have seen firsthand the positive impact our practices have had on improving patient care. For this reason, we will continue to work towards breaking down barriers posed by Stark Law to deliver the optimal care our patients deserve.

Without the support of Members of Congress, we cannot properly address patient needs while transitioning away from the outdated fee-for service model. We need strong leadership and support for the Medicare Care Coordination Improvement Act of 2017 so that patients can have full access to take advantage of the services and expertise offered by their independent physicians.

Neal D. Shore, MD, FACS is the president of LUGPA, a trade association that represents independent urology group practices in the U.S., with more than 2,300 physicians who make up more than 25 percent of the nation’s practicing urologists, and provide more than 30 percent of the total urologic care in the U.S.

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