To Better Improve Coordinated Care For Patients, HHS Proposes Overhaul For Rules Originally Aimed At Deterring Fraud
As the medical landscape moves more toward coordinated care between providers and specialty physicians, officials say the old rules have become a roadblock rather than a protection for patients.
The Associated Press:
Overhaul Is Proposed For Decades-Old Medicare Fraud Rules
The Trump administration on Wednesday proposed overhauling decades-old Medicare rules originally meant to deter fraud and abuse but now seen as a roadblock to coordinating better care for patients. The rules under revision were intended to counter self-dealing and financial kickbacks among service providers such as hospitals, clinics and doctors. (Alonso-Zaldivar, 10/9)
Modern Healthcare:
New Anti-Kickback Rules Offered To Protect New Healthcare Pay Models
"President Trump has promised American patients a healthcare system with affordable, personalized care, a system that puts you in control, provides peace of mind, and treats you like a human being, not a number. But too often, government regulations have stood in the way of delivering that kind of care," HHS Secretary Alex Azar said in a statement. "Our proposed rules would be an unprecedented opportunity for providers to work together to deliver the kind of high-value, coordinated care that patients deserve." (Brady and Teichert, 10/9)
Reuters:
Trump Administration To Announce Changes To Anti-Kickback Rules For Healthcare Providers
HHS will create exceptions for healthcare providers that enter into agreements with other parties if they are aimed at cutting costs and improving patient health, the officials said. Trump issued an executive order last week that sought to woo seniors by strengthening the Medicare health program. (O'Donnell, 10/9)
The Hill:
Trump Officials Move To Ease Doctor Anti-Fraud Rules In Modernization Bid
The very technical changes in the new proposed rules would create exceptions that allow for “value-based” payment arrangements, which is where doctors get paid more if their patients get better results. Officials say there would still be rules against actual fraud. Those new payment arrangements are viewed by members of both parties as an important step in modernizing the health system and saving money in the long term by taking away incentives for doctors to simply order many tests and procedures because they get paid for each one. (Sullivan, 10/9)
Bloomberg Law:
Trump Moves To Ease Anti-Fraud Rules In Bid To Improve Care
Some of the ways that physicians want to coordinate care are not always illegal under the laws, but they may be effectively prohibited because of the difficulty in understanding the laws’ provisions, Eric Hargan, deputy secretary of the Department of Health and Human Services, said in a call with reporters. The penalties for both laws are steep, and attorneys say the laws currently prevent doctors from trying to find better ways to work together. A hospital could run afoul of the laws if it offers incentive payments to physicians for providing more efficient and cost-effective care, for example. (Stein, 10/9)
Axios:
Health Care's Fraud And Abuse Laws Are Getting Overhauled
Between the lines: The overarching concern is everyone's definition of "value" is different. How will regulators know whether providers are acting in good faith to coordinate care, or if they are using "value-based care" as a cover to control patient referrals and enrich themselves? (Herman, 10/10)
Modern Healthcare:
Cybersecurity Exception Is Part Of Anti-Kickback Enforcement Proposal
A proposed exception to enforcement of HHS' anti-kickback laws would allow hospitals to give free cybersecurity software to local providers they work with frequently, as part of an effort to facilitate more coordinated patient care. The exception is part of a long-awaited proposal HHS unveiled Wednesday, which suggests changes to Stark law kickback protections the agency said "unnecessarily limit" coordinated care. (Cohen, 10/9)
CQ:
Health Industry Cheers Anti-Kickback Plan But Has Some Concerns
Health care groups quickly applauded the Trump administration’s proposed changes to two anti-corruption laws, which followed years of industry pleas for updates. The proposals, unveiled Wednesday by the Centers for Medicare and Medicaid Services and the Office of the Inspector General, seek to clarify and expand exceptions to the Stark physician self-referral law and anti-kickback statute in a bid to spur innovative care. The laws restrict doctors from referring Medicare and Medicaid patients to other organizations with which the doctor has a financial relationship, or from receiving compensation for Medicare and Medicaid patient referrals. (Clason, 10/10)
