On Aug. 23, the ACC submitted comments to the Centers for Medicare and Medicaid Services (CMS) in response to the agency's request for information on the physician self-referral law, commonly known as the Stark law, as published on June 25.

The Stark law poses a significant administrative burden on clinicians, impeding their ability to focus on patient care by imposing significant hurdles to innovation in care delivery models – innovation that Congress, CMS, clinicians and the American public have recognized as essential to improving care quality and increasing patient engagement.

The ACC's comments urged CMS and Congress to undertake a thorough, holistic review of the Stark law to determine whether it remains relevant in today's evolving health care system, and whether the benefits justify the regulatory burden it has come to represent. If, upon the conclusion of that review, it is apparent that the Stark law is impeding progress towards achieving higher quality and more cost-effective care, the ACC calls upon Congress and the Administration to take the steps necessary to remedy the situation.

The College also recommended that CMS focus on the stated desires of all stakeholders when considering changes to the system used by Medicare for clinician compensation, specifically when considering experimentation with and development of alternative payment models. It is not presently clear that leaving the Stark law in place will drive higher quality, higher value care as laid out in the Medicare Access and CHIP Reauthorization Act (MACRA). Rather, the regulatory burdens and risks associated with the law deter physicians from pursuing new, innovative arrangements.

Recent experiences with the limited waiver of Stark and other regulatory restraints to promote accountable care organizations (ACOs) as part of health reform have been telling. If the law must be waived to accomplish health care reform goals overwhelmingly supported by Congress, CMS must question whether the law should be substantially changed or eliminated entirely. Furthermore, cardiovascular care team members report that even with the ACO waivers in place, certainty remains elusive.

In 2016, the ACC adopted a series of principles to guide discussions regarding Stark law revisions. The principles prioritize the reduction of administrative burden, improved access to quality care, collaboration among clinicians across health systems to promote team-based care, emphasizing quality measurement through the use of outcome-based clinical data registries, such as the National Cardiovascular Data Registry, and more.

ACC Advocacy staff will continue to closely monitor developments on this issue and communicate updates to ACC members on ACC.org, through @Cardiology on Twitter and through the Advocate newsletter.

Clinical Topics: Cardiovascular Care Team

Keywords: ACC Advocacy, Physician Self-Referral, Health Care Reform, Accountable Care Organizations, Centers for Medicare and Medicaid Services, U.S., Patient Participation, Medicare, Medicaid, Physicians, Patient Care, Quality of Health Care, Registries

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