decisionhealth Newsletters, Part B News - 2018 Issue 4 (April)
Foot-dragging on Stark reform leaves APMs at risk, slows growth of program
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Article Overview
This article examines the policy and compliance issues surrounding Stark law reform as they relate to alternative payment models under MACRA and the Quality Payment Program. It discusses congressional attention, CMS and HHS roles, related fraud-and-abuse laws, and why providers and health care organizations are concerned that existing rules may complicate APM participation and growth. The piece is aimed at readers following Medicare payment policy, health law, compliance, and provider-side payment model design.
Why This Topic Matters
It helps readers understand why fraud-and-abuse law reform is seen as a barrier or enabler for APM adoption, and why the issue matters for providers, health systems, and policymakers working on Medicare payment reform.
Article Sections
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Congressional and CMS attention to Stark reform
This section covers the policy discussion that brought Stark law back into focus, including congressional questioning and CMS commentary in the context of MACRA and payment reform.
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Why Stark law creates compliance risk
This section discusses the general compliance concerns associated with Stark and related fraud-and-abuse rules, including the broader legal risk environment for provider arrangements.
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ACOs, APMs, and waiver issues
This section compares how different Medicare payment models intersect with fraud-and-abuse exceptions and waiver authority, and it addresses concerns about model design and regulatory coverage.
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Practical impact on APM development
This section focuses on the effect of these legal and regulatory issues on the development and approval process for alternative payment models and related provider participation.
What You Will Learn
- How Stark law is being discussed in relation to Medicare payment reform
- Why fraud-and-abuse rules are seen as a challenge for alternative payment models
- What roles CMS, HHS, and Congress play in payment model policy
- How compliance concerns can affect provider participation in new payment arrangements
Who Should Read This
- Medical coders
- Health care compliance professionals
- Health law attorneys
- Provider billing and reimbursement staff
- Hospital and physician practice administrators
- Policy analysts following Medicare payment reform
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