The Federal anti-kickback laws have been in effect since 1972.  Their purpose is to help reduce fraud and abuse in healthcare by making it illegal for physicians to receive any payment for influencing any specific treatment protocols or procedures.  Simply stated, physicians may not receive any form of compensation for referrals or prescribing medications or treatments.  The idea behind both the Stark Law and Anti-Kickback Statute (AKS) is that, by eliminating any potential influence as a result of such kickbacks, treatments will be entirely based on patient welfare, resulting in better outcomes.

The challenge is these laws were written under the assumption that physicians are paid based on volume, which has been the longstanding practice in U.S. healthcare.  With an overburdened healthcare system that is facing a continued increase in older patients and patients with chronic conditions who require regular care, the fee-for-service model is no longer able to keep the system functioning efficiently.

Instead, the industry is shifting to a value-based care model, which rewards physicians for quality of outcomes and preventative care.  Connected health solutions, like telehealth and remote patient monitoring, can help drive the healthcare model to focus on value thanks to several benefits.

Access

Ensuring access to the most appropriate providers, regardless of geography, to ensure patients receive the treatment they need for their particular conditions.

Efficiency

Reductions in wait times, automated process and data entry, patient portals and apps for scheduling and follow-ups, and more convenient appointments all can help improve process efficiency.  Physicians are able to spend more time treating more patients, instead of becoming burdened by paperwork and other manual tasks.

Care Coordination

Physicians can more easily involve colleagues, families, and other caregivers in treatment and care efforts by being able to share patient data and information.

Monitoring

RPM devices and applications can not only make monitoring existing conditions easier, but can help track at-risk patients to enable earlier interventions.

The Department of Health and Human Services (HHS) is looking to make it easier for physicians to leverage many of the new technology solutions that can help deliver efficient and high quality care under a fee-for-value model.  It has recently proposed amendments to the Stark Law and AKS that would specifically permit value-based arrangements and coordinated care efforts that are enabled by connected health solutions, yet are, at best, unclear under the current versions.

Specifically, HSS is recommending a series of exceptions to the Stark Law and several Safe Harbors to the AKS, to protect remuneration between healthcare providers and other entities that have entered into value-based arrangements.  If passed, these amendments would make it easier for physicians to leverage telehealth and remote patient management for better care, without fear of regulatory violations, and transition to a value-based care model.

The proposed changes include Safe harbors that would extend protections for participants in value-based arrangements that enable better coordinated and managed patient care, defined by the level of financial risk assumed:

  • Care coordination arrangements to improve quality, health outcomes, and efficiency,
  • Value-based arrangements with substantial downside financial risk, and
  • Value-based arrangements with full financial risk.

Additional proposals seek to better clarify patient engagement and ongoing support methods and solutions designed to improve quality, health outcomes, and efficiency, as well as donations of cybersecurity services and solutions that would help protect and secure sensitive patient data and EHRs, which are critical to the ongoing success to connected health growth and value-based healthcare.

The goal of the proposed amendments is to make it easier to transition to a value-based model and to make it easier for physicians to use and recommend connected health services is a key to its success.

To learn more about how connected health solutions can help deliver higher quality care and better patient outcomes, connect with us here.

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