Advocacy leaders at both the Englewood, Colorado-based Medical Group Management Association (MGMA) and the Alexandria, Virginia-based American Medical Group Association (AMGA), the two largest nationwide associations representing medical group executives, submitted comments to the Center for Medicare & Medicaid Services (CMS), regarding the agency’s proposed changes to the Stark physician referral law, and its proposals to changes in the anti-kickback statute and the self-referral rule.
In a letter representing MGMA, Anders Gilberg, senior vice president of government affairs, wrote to CMS Administrator Seema Verma on Dec. 19 that “The new value-based arrangement exception could provide a clearer pathway for practices entering into value-based payment arrangements where there exists no viable pathway today,” said Anders Gilberg, Senior Vice President of Government Affairs. “We appreciate the Agency’s recognition that not all group practices are prepared to assume financial risk yet may still be interested in developing innovative, integrated arrangements."
Still, Gilberg wrote, “Notwithstanding the value-based care improvements, the rule could have done considerably more to reduce the regulatory burden that Stark places on medical groups. Instead, it potentially adds to it.” Indeed, he wrote, "In our detailed comments, we strongly oppose further efforts to micromanage the organization, governance, and operation of group practices. This includes new CMS proposals, which would interfere with legitimate group practice compensation formulas," said Gilberg. "CMS leadership has been open to hearing our concerns and we are optimistic that the final rule will contain significant revisions in this area."
Meanwhile, on Dec. 31, AMGA announced that, too, had filed letters regarding CMS’s proposed changes to the anti-kickback statue and the self-referral rule. In a public statement released on the same day, the association stated that “AMGA today recommended that providers have access to a regulatory framework that supports their ability to assume risk-based contracts. In comments filed today on proposals from the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) and the Centers for Medicare & Medicaid Services (CMS), AMGA recommended safe harbors under the Anti-Kickback Statute and exceptions from the Physician Self-Referral Law (Stark Law) address the complex regulatory and legal structure that hinders adoption of value-based care. AMGA urged OIG and CMS to create a consistent framework as providers take on increasing amounts of risk and not treat safe harbors and exceptions as incentives to move into value-based models. In addition, AMGA advised that OIG’s safe harbors should not offer different protections for different levels of risk, as this requires providers to revise their practice patterns as they assume additional financial risk.”
In that public statement, the association quoted its president and CEO, Jerry Penso, M.D., M.B.A., as stating that “It’s encouraging that HHS recognizes the barriers that the Anti-Kickback and Stark laws can have for providers who want move into a value-based model. By aligning their proposals and ensuring they are not structured on the amount of risk at stake, but based on a predictable framework, these rules will foster innovation in care coordination and management,” Dr. Penso said.
And, the association stated that, in its letters, “AMGA recommended that the OIG finalize its proposal to create a safe harbor in connection with CMS-sponsored models. This will alleviate the need for providers to seek distinct fraud-and-abuse waivers. Regarding the CMS rule, AMGA supports the proposed exceptions that would apply to value-based arrangements. AMGA recommended that CMS not finalize a proposed change to its definition of group practices, as doing so would be disruptive to multispecialty medical groups and organized delivery systems.”
AMGA’s full comments on the proposed Anti-Kickback Statute proposed rule are available here, and its comments on the proposed Physician Self-Referral rule are available here.
