As the Centers for Medicare & Medicaid Services (CMS) continue their initiative to move healthcare towards a value-based care system, which is a form of reimbursement that ties payments for care delivery to the quality of care provided and rewards providers for both efficiency and effectiveness, one particular regulation stands in their way – the Stark law. The Stark law, which serves to restrict Medicare and Medicaid spending by constraining physicians for creating referrals that can financially benefit the physician, is hindering the progress for physicians to adopt value-based care reimbursement models. Along with the federal anti-kickback statute, the new payment models for value based care have seen a slow rise.
The switch from volume-based reimbursement models to a value-based reimbursement model has moved slowly, due to fraud and abuse laws, which don’t support reimbursement models focused on efficiency and quality. According to a survey conducted by Advis, over 36% of 162 healthcare executives surveyed had stated that the fraud and abuse laws are what is hindering the new care models. Abiding by these fraud and abuse laws are part of the conditions to participate in Medicare.
The area of how the Stark law aligns with the new reimbursement models does not have very much clarity, and the industry seeks reform. Advis President and CEO Lyndean Brick stated, “The industry is seeking some simplicity to this complex regulatory landscape that has not caught up with the operational realities of the practice of healthcare today. Until we make significant changes to the anachronistic regulatory system, it will be difficult for providers to be cost effective, transparent and consumer focused.”
Read the original article from Modern Healthcare here.