AMGA Asks CMS to Reform Stark Law Regulations to Encourage Adoption of Value-Based Payment Models

Alexandria, VA – AMGA today encouraged the Centers for Medicare & Medicaid Services (CMS) to help foster care coordination and the adoption of value-based payment models by reforming its Stark law regulations.

In response to a June 25 Request for Information (RFI) from CMS on the Physician Self-Referral (Stark) law, AMGA acknowledged related statutory limitations the agency faces and welcomed the request’s intent to obtain insights regarding how CMS can better regulate Stark law, especially as it relates to fielding Medicare pay-for-performance (P4P) models of care, particularly Accountable Care Organizations (ACOs).

AMGA provided comments on the timing and availability of Stark law waivers, how the law should be applied to Alternative Payment Models (APMs), and how transparency can better inform Medicare beneficiaries’ decision-making.

“The intent behind the Stark law, as Congressman Pete Stark himself admitted, was to create bright line rules so physicians can police their own behavior and not get distracted from focusing on improving care delivery,” said Jerry Penso, M.D., M.B.A., AMGA president and chief executive officer. “New innovative models of care present a challenge for regulators who want to improve care coordination and outcomes via incentivized value-based arrangements without creating legal uncertainty in advancing these goals. CMS is in a difficult position, but there are regulatory improvements, however incremental, that can be made to Stark.”

For example, AMGA recommended CMS provide the time and flexibility needed to amend changes in practice patterns that were implemented as part of participation in an ACO. Rather than end waiver authority immediately upon an exit from the model, CMS should provide healthcare providers with additional time to come into compliance and should keep waivers in place if they participate in other, non-Medicare APM models that include Medicaid and/or commercial plans.

The letter is available on the AMGA website.

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About AMGA
AMGA is a trade association leading the transformation of health care in America. Representing multispecialty medical groups and integrated systems of care, we advocate, educate, innovate, and empower our members to deliver the next level of high performance health. AMGA is the national voice promoting awareness of our members’ recognized excellence in the delivery of coordinated, high quality, high-value care. More than 175,000 physicians practice in our member organizations, delivering care to one in three Americans.