Stark Law Legislation

The Effects of the Stark Law on Healthcare Administrators

The Healthcare Information and Management Systems Society (HIMSS) recently informed Seema Verma, the administrator of the Centers for Medicare & Medicaid Services (CMSS), that the Physician Self-Referral Law – perhaps more commonly known as the Stark Law – burdens providers administratively and hinders the exchange of health data and coordination of care unnecessarily. Instead, HIMSS recommended that CMS rework the regulations of Stark Law with an emphasis on a flexible framework that alternative payment models (APM) require in order to be successful. Changes to those regulations, advised HIMSS, should ensure that the Stark Law doesn’t interfere or prohibit care coordination or health data exchange.

According to a letter addressed to Administrator Verma, HIMSS stance includes allowing physicians to use more APM self-referral law waivers – much in the same way that the agency already allows waivers to be used in a number of innovation models that CMS is currently piloting. As an example, HIMSS pointed to the Medicare Shared Savings Program (MSSP) and the way it provides incentives for providers to not only improve the quality of care but also to do so while reducing costs and the utilization of resources. The organization noted that these efforts would require the type of coordination that isn’t likely to be possible in a typical relationship that is fee-for-service based, however. For this reason, HIMSS recommended that CMS allow patient access to care via APMs by using its authority to issue waivers.

HIMSS encouraged CMS to enable the waiver authority to be designed without the focal point being the potential of financial implications for physician referrals. It also recommended that the waiver authority is aligned across all of CMS’ programs, including any testing of news and/or innovative service delivery and payment models. Following these steps will help reduce the administrative burden on providers significantly.

Allowing waivers for the Stark Law will also facilitate the exchange of health data, according to HIMSS. Under their current form, self-referral laws serve to limit the flow of information between organizations. As it stands now, in order to share information, providers must implement, use and maintain tools that not all of them can afford. These include access to multiple interoperability networks, exchanges, and approaches that are designed to share information across the complex care continuum.

HIMSS recommends that the current regulations for self-referral be changed so that, going forward, physicians aren’t prohibited by a data sharing scenario that hinders the care coordination for patients. Instead, Stark Law policies should reflect and support the aims of the MyHealthEData initiative.

Under this initiative, which was released earlier in 2018 by the Trump administration, patients are given more control of their healthcare data by removing the existing barriers that hinder their access and use of this information. As it currently stands, the reporting requirements and regulatory burdens contained within the Stark Law deter physicians from working to exchange health data with some providers. The Stark Law also affects the quality of care afforded patients in a negative manner, according to the HIMSS letter.

HIMSS encourages transparency between patients and their healthcare providers in reference to referrals. Using data gleaned from CMS quality rating programs, providers should also be encouraged to discuss potential advantages and disadvantages of care settings. Another noteworthy mention contained in the HIMSS letter to CMS drew attention to the fact that provider access to services for cybersecurity is inhibited by the Stark Law in its current form.