Dear Chairmen Hatch and Brady:
On behalf of the undersigned organizations, we would like to thank you for requesting our
views on how the Physician Self-Referral law (“Stark Law”) can be modernized to reflect
the evolution of health care delivery models.
Enactment of the Medicare Access and CHIP Reauthorization Act (MACRA) fundamentally
transformed how health care is delivered and provides important opportunities to move
toward value-based payment paradigms rather than the historical fee-for-service model.
Coordination of care within and across specialties is essential to improve patient outcomes
and constrain overall health care costs. The structure of the Stark law has not been
updated statutorily for more than two decades, and is now an anachronistic hindrance to
the twenty-first century delivery of health care and a limitation to the full potential
envisioned by Congress when it enacted MACRA.
The complexities of the Stark law regulatory infrastructure make it burdensome for
clinicians to comply. For example, the “group practice” definition places strict limits on the
ways that a physician practice may compensate its owners. In addition, agreements with
physician contractors must satisfy seven distinct regulatory conditions, making them prone
to technical infractions. Unlike other laws that regulate healthcare, the Stark law does not
require demonstration of intentional offers of remuneration to induce referrals or any risk
to patient care. Current waivers are skewed toward primary care and financial
relationships with hospitals. It is critical to incorporate protections for independent
specialty groups. Finally, the Stark law impedes care coordination outside of Medicare – a
key avenue to qualify for an Alternative Payment Model (APM) in MACRA – due to the Stark
Law’s consideration of “other business generated” in its limitations on referrals.
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