October 9, 2019

The well anticipated proposed Stark Law and Anti-Kickback changes are finally here in an effort to allow for greater integration between hospitals and physicians through coordinated care and value-based arrangements.  The overall consensus seems to be positive with the attempt to bring clarity to the regulatory framework and account for modernized arrangements.  The proposed changes recognize that today’s healthcare systems face challenges to improve patient care that require a coordinated effort amongst the players in the system.  Paying for value is different from paying based on volume and the regulatory language as written today limits this effort.

While the changes are significant, it appears that the Department of Health and Human Services Office of the Inspector General presented their proposed changes with the intent to compliment the law and not overturn the primary purpose of the law.  It will still be imperative for healthcare systems to consider each arrangement within the context of fair market value and commercial reasonableness in order to ensure that the transaction does not incentive overutilization and/or overpayment for services.

As a medical provider of nearly 20 years, I welcome greater coordinated care in an effort at improving healthcare for all patients.  Providing care across different settings as patients travel back and forth between home, the outpatient office and the hospital can only improve with greater communication and interdependence.  I am excited to see what unique and innovative arrangements are on the horizon.  As a healthcare valuator of over 20 years, these new arrangements bring new challenges in appropriately capture value associated with quality.  With the goal of a better health system and a more healthy population, I look forward to the challenge.

Click here to read more from Modern Healthcare article.

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