WHA Comments on CMS Physician Self-referral “Stark Law” RFI

Urges CMS to reform outdated regulations to improve care and value in Medicare

August 28, 2018

Last week, WHA submitted a comment letter in response to the Request for Information (RFI) from the Centers for Medicare & Medicaid Services (CMS) on the physician self-referral law, more commonly referred to as the Stark Law. As covered in previous Valued Voice articles, the Stark Law has its roots in a 1989 law named after its lead author, former California Congressman Pete Stark. In an era where Medicare paid health care providers based on the volume of services provided, its goal was to ensure physicians refer patients for services and tests based only on whether they are necessary by prohibiting physicians from receiving financial incentives for such referrals.
The RFI from CMS asked for feedback on how the law’s numerous regulations impact integrated delivery models, alternative payment models, and arrangements designed to reward quality over volume. In its comment letter, WHA suggested CMS focus on clarifying confusing definitions, providing clearer exceptions, focus on routing out intentional rather than unintentional violations, and harmonizing the Stark Law with the antikickback statute which contains regulations that often overlap with Stark.
The comment letter also highlighted Wisconsin’s reputation for high-quality, high-value health care, and suggested CMS’ reform its payment structure to reward high-value states like Wisconsin and incentivize other states to make similar quality improvements. WHA noted the Stark Law currently serves as an impediment to hospitals looking to form innovative payment arrangements that reward physicians for improving quality. WHA will continue to advocate for Stark Law reform with CMS and Congress in its federal lobbying efforts.

This story originally appeared in the August 28, 2018 edition of WHA Newsletter