CMS overhauls physician self-referral regs, while doc groups say Stark Law still ‘beyond comprehension’
The Centers for Medicare and Medicaid Services issued what it called “historic” updates to physician self-referral and anti-kickback regulations late Friday in a bid to spur innovation. But doc groups are concerned the Stark Law is still far too “vexing” for the average provider.
CMS has long discussed modernizing its approach to this issue, originally implemented in 1989 to prevent physicians from steering patients to entities in which they have a financial interest. The final rule issued Nov. 20 would, among other things, create new exceptions for value-based care models and reduce administrative burdens on practices.
Some, such as the Medical Group Management Association — which represents 55,000 practice leaders, in radiology and other specialties — said they appreciated efforts to simplify such statutes. However, these regulations are still difficult for most docs to interpret.
“The final rule could have gone further to reduce the overall complexity and regulatory intrusion into group practice operations,” Anders Gilberg, senior VP of government affairs for the MGMA, said in a statement issued Monday. “Despite countless rulemakings, each of which identified legitimate problems with Stark Law regulations and attempted to fix them, the regulatory scheme has grown in complexity to the point where it is beyond comprehension to the average physician or practice administrator.”
Gilberg believes the law’s “strict liability regime, disproportionate penalty provisions and vexing construct,” continue to undercut any reform efforts, adding that there is “significant need” for congressional intervention.
In a fact sheet accompanying the 627-page rule, CMS noted that the Stark Law has not evolved to keep pace with healthcare’s transition to value. Some facets of the regulation serve as roadblocks, even, preventing providers from arrangements meant to enhance care coordination, improve quality and reduce waste.
CMS said its new overhaul includes a “comprehensive package of reforms,” creating permanent exceptions for value-based care. Administrator Seema Verma said the agency has heard “repeatedly from front-line providers that our outdated Stark regulations saddled them with costly administrative burden and hindered value-based payment arrangements.”
“That sound you hear is the mingled cheers and exclamations of relief from doctors and other healthcare professionals across the county as we lift the weight of our punishing bureaucracy from their backs,” she said in a statement.
The American College of Radiology did not have comment on the final rule Monday, according to a spokesman. However, in comments submitted on the proposed rule last year, ACR said it “has strongly supported the Stark Law since its inception, especially in traditional Medicare fee-for-service systems.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.