Healthcare

Let's hear it for clarity! Thanks to the Department of Health and Human Services' (HHS) revision of the Physician Referral Law (aka Stark law) in November 2020, we now have more explicit guidance for the key definitions. And for physician compensation experts, it's about time.

On Friday, November 20, the U.S. Department of Health and Human Services (HHS) published the long-awaited final rules revising regulations related to the Physician Self-Referral Law (known commonly as the Stark Law), the Anti-Kickback Statute (AKS), and the Civil Monetary Penalty Law (CMP). The revised regulatory framework for these two laws is intended to reduce barriers to care coordination and promote alternative payment models that focus on increasing value and delivering care in a more efficient and coordinated way.  

UPDATED April 8, 2020

On March 29, CMS issued blanket waivers of the Physician Self-Referral Law (commonly known as the “Stark Law”) to cover financial relationships and referrals related to the COVID-19 pandemic in the United States.  

UPDATED April 7, 2020: There have been updates to the proposed rule which can be found here. 

Telehealth services have become even more critical in caring for patients as the COVID-19 pandemic quickly evolves. In order to temporarily remove barriers to practice telehealth, the Federal Government and many States are making sweeping changes in Telehealth Waiver provisions. 

In recent years, the use of care management services to provide better patient outcomes has gained momentum. Contributing to this momentum is a desire to generate greater transparency around patient behaviors in Post-Acute Care settings. This setting was the first focus area for the creation of care management services.

Legislative support is growing for the reimbursement of care delivery via telemedicine. The Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG) have recently made final and proposed rule changes to stimulate greater use and access for telemedicine delivery. These changes mean that for healthcare providers all around the United States, telemedicine will become a greater strategic focus.

Chalk one up for advocates of consumerism. CMS is encouraging price transparency with its FY2019 Inpatient Prospective Payment System (IPPS) rule released in August.

Wary of factors that are outside their control, almost two-thirds of healthcare leaders would rather bail out of their accountable care organizations (ACO) than make the leap to a model that includes downside risk.

The old adage, "Money can make you do crazy things," can easily be applied to both our personal and business lives. Within the healthcare industry, HITECH incentive payments were offered by the U.S. government several years ago to implement electronic health record (EHR) systems at hospitals and other healthcare organizations. In order to qualify for these incentive payments, healthcare organizations were required to carry out regular security risk assessments to show they were meeting the HIPAA Security Rule requirements. While a large number of healthcare organizations properly followed the rules and carried out the security risk assessment required, a select number received the incentives without doing so.

If your hospital or clinic uses a Windows 7-based version of a Siemens PET/CT or SPECT system, it could be vulnerable to attack by a relatively low-skill hacker, according to a July 26 security advisory from the company.

Risk tolerance is an interesting thing. Those who make the biggest bets often are actually control freaks—maybe because they know that, by having a strong grasp on the factors that influence the deal, they greatly increase the likelihood that they will come out ahead.

A Bridge for Healthcare Reform

Over the past decade, clinical co-management arrangements (CCMAs) have risen in popularity as a means to achieve a more integrated care delivery model. CCMAs have often been touted as an interim strategy to bridge hospitals to newer emerging models, but many hospitals have yet to cross that bridge.

MACRA’s anticipated future impact on the healthcare industry has many provider organizations contemplating what actions and resources are necessary to participate in alternative payment models (“APMs”). Provider organizations facing the immediate options of getting involved with a CMS or commercial APM have significant operational decisions to make that will impact the future make-up of their organizations. Today we will discuss some of the considerations in preparing for APM participation.