Congress Considers Changes to Stark and AKS

Posted on
September 12, 2018

The Department of Health and Human Services announced a “regulatory sprint to coordinated care” in June 2018, a new initiative to remove regulatory barriers that impede the transition to a coordinated, value-based health delivery system.

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The Department of Health and Human Services announced a “regulatory sprint to coordinated care” in June 2018, a new initiative to remove regulatory barriers that impede the transition to a coordinated, value-based health delivery system. The debate includes a discussion on the impact of Stark and AKS regulations. This summer, government agencies have been attacking these questions head on. Two Requests for Information have been published and CMS held their comment period on Stark, or the Physician Self-Referral Law. The OIG has focused primarily on AKS and how to add or alter AKS safe harbors. The comment period will end at 5pm on October 26.

It is unclear how AKS and Stark rules impede value-based care. Many argue that laws like AKS were written with a pay-for-service model in mind, and not the pay-for-performance model that today’s health leaders are working to build. Gainsharing and co-management agreements are two of the types of physician agreements that must be structured carefully to address potential regulatory concerns. The OIG aims to gather feedback on the details and exceptions to AKS that are particularly difficult for health care organizations to navigate as well as identify new safe harbors or changes that would actively promote value-based care.

Various organizations have submitted responses to both RFI’s. In response to CMS’s RFI, The American Hospital Association wrote:

To reach the full potential of a value-based system, the Stark compensation regulations must be reframed to meet the objectives of the new system, through the creation of a new exception designed specifically for value-based payment methodologies, and reforms to the personal services, employment, and risk sharing exceptions.

What should we expect moving forward? For now, officials only seem to be considering small adjustments to the laws and regulations, in response to the large number of comments from industry leaders. How far they’ll go after that, we’ll have to wait and see.

Do you have further questions about how to structure physician contracts and document compliance? Does your organization need support to build a strong compliance program? We would love to talk to you. Email us at info@mdranger.com.


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