One can argue that value-based care is clearly in the patient’s best interest. Such arrangements allow for the patient to receive care from multiple specialists and reduce the financial burden that may come with visiting more than one physician. However, lawmakers have voiced concerns about under the table arrangements between medical professionals that focus on financial gain as opposed to the patient’s quality of care. These concerns, unfortunately warranted at times, have led to legislative hurdles to these arrangements.
Although cases of medical professionals entering arrangements that resulted in their own personal financial gain over the wellbeing of their patients are present, the regulations passed by lawmakers to help thwart these bad characters also hindered professional collaboration. Lawmakers have moved forward with recent changes to the Stark law and Anti-Kickback Statute (AKS) to lower these hurdles and encourage beneficial professional collaboration within the healthcare industry.
The changes result in new exceptions and safe harbors that protect certain value-based care arrangements. Examples include coordinating care of target patient populations and taking steps to transition from healthcare delivery based on volume to those based on quality of care and cost control. In the past, groups that would take advantage of similar exceptions would need to get fair market value appraisers to help guide appropriate compensation for these arrangements. This hurdle was also lowered, as it appears the HHS will now rely on a commercial reasonableness standard for pay in these arrangements.
Practices that are looking to take advantage of these new opportunities can conduct internal audits to review potential arrangements before moving forward with the agreement. This will help to better ensure their business is in line with applicable regulations.