Stark Law and anti-kickback statutes create obstacles to developing alternative payment models suited for independent specialty practices, Large Urology Group Practice Association President Neal Shore, MD, told EHRIntelligence.com.
Dr. Shore shared his perspective on how federal regulations hurt independent practices. Here are five key points he made:
1. Stark Laws provide barriers to advanced APMs that prioritize and incentivize care coordination because it prohibits Medicare claims submitted for services resulting from physician referrals if a financial relationship exists with the referring physician.
2. To address the challenges, CMS is seeking recommendations on how to reduce regulatory burdens created by Stark Laws. Dr. Shore said the solution to reducing regulatory burdens lies in collaboration between CMS and large, independent practices participating in APMs.
3. Dr. Shore and LUGPA have championed the Medicare Coordination Improvement Act, which targets certain statutes that inhibit care coordination.
4. Dr. Shore said Stark Law and anti-kickback laws are designed for a fee-for-service healthcare system rather than a value-based system, so CMS should prioritize updates to the policies.
5. Certain Stark Law provisions, such as self-referral exceptions for health systems with same-network ancillary specialties, are unfair to stand-alone specialty independent practices, according to Dr. Shore.
"It creates, frankly, a competitive advantage for larger hospital systems," he said. "That's a big part of the problem. And when you're seeing all this aggregation of large hospital systems, it's really allowing for an unfair and unbalanced playing field."