UPDATED Oct. 9, 2019, with comments from press briefing in Minneapolis.
The U.S. Department of Health and Human Services today proposed what it’s describing as a modernization of the physician self-referral law in order to promote value-based healthcare.
The proposed regulatory changes, which are heading into a 75-day public comment period, say the physician self-referral law may actually have a “chilling effect” on the value-based care initiatives. The proposals are meant to provide exceptions for doctors in value-based arrangements.
“Regulatory reform has been a key piece of President Trump’s agenda not just for faster innovation and economic growth, but also better, higher-value healthcare. 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,” HHS Secretary Alex Azar.
During a press briefing at Mayo Clinic Sports Medicine in downtown Minneapolis this afternoon, CMS Administrator Seema Verma spoke of “leaning into innovation, not shying away from it by imposing more government controls.”
Enacted by Congress in 1989 and expanded in 1993, the physician self-referral law prevents doctors from referring Medicare and Medicaid patients for services at other health entities where the doctors or their immediate family members have financial interests. The goal of the law is to prevent physicians from financially gaining from racking up charges with public health insurance providers. Exceptions to the rule reflect the structure of the fee-for-service healthcare system that’s existed in the U.S. for recent decades.
Under the Obama administration and now the Trump administration, however, there’s been a push to use Medicare and Medicaid to transition health providers toward more value-based arrangements where compensation is based on how efficiently and effectively certain patient populations are managed.