2. Stark Law
Emily Felder, senior policy advisor and counsel with D.C.-based Brownstein Hyatt Farber Schreck, a lobbying firm specializing in healthcare, notes HHS is rewriting the rules for the Stark Law, or physician self-referral, and will issue a proposed rule later this year. That will set up 2020 as the year to debate the proposed changes and a broader discussion about the role of Stark in managed care.
CMS Administrator Seema Verma has called Stark “outdated” and said while it makes sense in a fee-for-service (FFS) system to prevent inappropriate financial incentives, it doesn’t apply the same way to managed care and value-based systems.
“Changes to Stark will be largely positive for two reasons,” Felder says. “One, the administration is aware that the 30-year-old law needs to be updated and adapted for today’s evolving system, and two, there is commitment and action to make it reflect the intent of the law. The administration sees these changes as part of the larger ‘Regulatory Sprint to Coordinated Care.’”
3. Price transparency
John Nicolaou, healthcare expert at PA Consulting, a global healthcare consultancy with U.S. offices in New York, says the price transparency regulation proposal, started by executive order earlier in the year, and now part of a CMS proposed rulemaking, is currently in comment period.
“This would require hospitals to publish gross and negotiated rates for services in an accessible format, including commonly used ‘bundles’ of services,” he says.
Robbie Hughes, founder and CEO of Lumeon, a digital health company leveraging Care Pathway Management, based in Boston, expects that heading into 2020 there will be more movement around Trump’s order on price transparency, aimed at lowering rising costs of care by showing prices upfront to patients.
“The executive order describes the concept of price transparency as the means to creating a ‘shoppable’ experience—the idea that there could be packages of care at understandable, logical prices,” he says. “Not only will this force providers to package their care into ‘shoppable’ products for consumers, but it will also ultimately drive down prices through market forces.”
The ideas in this executive order will likely be reflected in a bigger policy package that will need bipartisan support and approval from both houses in Congress.
“Nobody will disagree on making it easier and more affordable for Americans to consume healthcare,” Hughes says. “The challenge I anticipate we’ll see is around industry agreement on an approach that ensures the consumer sees the benefit of reduced healthcare costs.”