The American College of Radiology (ACR)'s July 27 written response to a request for information (RFI) from the House Health Care Innovation Caucus cautions against wholesale changes to federal self-referral law, promotes imaging preventive screening services and highlights how radiologists use health information technologies (HIT) to improve patient outcomes and lower costs.
The Health Care Innovation Caucus was recently formed by Reps. Mike Kelly (R-PA), Markwayne Mullin (R-OK), Ron Kind (D-WI) and Ami Bera, MD (D-CA). Its RFI sought feedback from stakeholders, including the ACR, pertaining to policy questions within the categories of “value-based provider payment reform,” “value-based arrangements,” and “technology and HIT.”
Efforts to relax the Ethics in Patient Referrals Act, commonly called the “Stark Law,” after its primary champion, former Congressman Fortney “Pete” Stark (D-CA), has recently attracted attention from the Department of Health and Human Services (HHS) and Congress. Under the Stark Law, doctors are prohibited from referring Medicare patients for designated health services, such as diagnostic imaging services, (e.g. X-rays, CTs, MRIs, and nuclear (PET) scans) payable by Medicare to entities in which they or any immediate family member have a financial interest. The law also prohibits medical providers from filing claims with Medicare or billing another individual, entity or third-party payer for such self-referred services. The Stark law is highly focused on banning self-referral or the practice of physicians referring patients to entities where they stand to benefit financially.
Members of the Health Care Innovation Caucus suggest Stark Law is too rigid, antiquated and stymies the movement of physicians towards alternative payment models (APMs), a key component of Medicare’s Quality Payment Program.
As part of a broader “Regulatory Sprint to Coordinated Care,” HHS issued a separate RFI June 20 on potential ways to relax existing Stark law prohibitions. In response to the RFI, the House Ways and Means Committee held a July 17 hearing that also focused on ways to modernize the existing statute.
In general, the ACR supports efforts by HHS and Congress to examine existing regulatory burdens and promote APMs, but in this instance, it is concerned about the unintended consequences of a broad rollback of Stark law restrictions. Since many questions posed by the House Health Care Innovation Caucus also focus on existing regulatory barriers blocking innovation, the ACR felt compelled to highlight its continued support for Stark law regulations in the traditional Medicare fee-for-service system. In addition, the College urged lawmakers to recognize that many current APMs still compensate advanced imaging services via unmanaged fee-for-service arrangements.
Consequently, the ACR’s comment letter encourages the House Health Care Innovation Caucus to reject appeals from outside stakeholders to provide blanket exceptions to the Stark law within value-based care systems. Modernizing the Stark law should be reserved for APMs that actively manage for appropriate utilization of diagnostic imaging services and are not paid on a volume-based fee-for-service basis.
The ACR recommended that the Health Care Innovation Caucus work with House leadership to promote access to screening services that utilize advanced imaging technology. In particular, the College highlighted the need for Congress to pressure the Centers for Medicare and Medicaid Services (CMS) to raise reimbursement rates for low-dose CT (LDCT) lung cancer screens, especially in hospital outpatient departments.
In addition, the ACR urged the caucus to use its collective influence to expeditiously pass H.R. 1298, the CT Colonography Screening for Colorectal Cancer Act. Passage of this bipartisan bill that, to date, has garnered more than 80 bipartisan cosponsors, including the Health Care Innovation Caucus’s Kelly, would ensure that patients, who follow current colon cancer screening guidelines and begin screening at age 50, will retain access to CT colonography without cost-sharing even after becoming eligible for Medicare.
The ACR’s letter also recommends additional public policies focused on promoting interoperability and image-sharing, preventing information blocking, adopting appropriate use criteria-based clinical decision support tools and supporting innovative technologies used by radiologists that leverage health care-augmented intelligence/machine learning methods.