Advocacy News

July 19, 2016



Change in Global Surgery Payment Policy

Bonefied News

CMS continues to allow a 90-day reporting period for Electronic Health Records (EHR) in 2016

Strengthening our Nation’s Trauma Care System

The Sports Medicine Licensure Clarity Act Passes Committee

Senate Finance Committee Holds MACRA Hearing

What We’re Reading

Representative Steny Hoyer’s Georgetown Law Lecture

Election 2016 Graphic of the Week

Stark Law Hearing

Pediatric Spinal Deformities

Expanding Uses of Medicare DATA by QE

The Orthopaedic PAC Capitol Club

AAOS Orthopaedic PAC Online Contribution Center


AAOS website

AAOS Calendar

House of Representatives Legislative Activities
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Stark Law Hearing

Chairman Orrin Hatch led a Senate Finance Committee hearing on Stark Law Reform on July 11. Many have suggested a complete repeal of the law, but some see certain sections of the law as extremely valuable.

Committee members expressed that America is moving away from fee-for-service medicine and instead moving towards a system that pays for quality of care over quantity. Value and efficiency numbers are rising in American hospitals. Healthcare has evolved since the Stark Law was enacted. Witnesses argued that it is important to promote coordination of care and uphold the principles of Stark Law. There need to be clear guidelines with referrals and doctor and patient care.

Three witnesses discussed the Stark Law. Troy Barsky, a healthcare and government healthcare lawyer, Dr. Ronald Paulus, President of Mission Healthcare Systems in North Carolina, and Mr. Peter Mancino, Secretary to the Board of Trustees for Johns Hopkins Health Systems.

In his testimony, Mr. Barsky stated that the law needs to be modernized in order to facilitate  a new era of healthcare. The Stark Law has evolved from a simple premise to a law with standards, definitions, exceptions, rules, and even exceptions to the exceptions. He also offered up some potential solutions for the current state of the Stark Law. He believes that the existing fraud and abuse provisions are good, but need to be adjusted, to avoid the one-size-fits-all approach. Bright line rules need to be established and CMS needs to be given authority to offer further guidance. Barriers need to be removed in order to prioritize furthering healthcare reform, and lastly, HHS needs to be encouraged to continue to expand waivers to boost innovative payment models and a unified approach to alternative payment models.

Dr. Paulus suggested that a full repeal would help to focus on transforming from a fee-for-service system to a value-based system.

Mr. Mancino was last to testify. He began by saying that the Stark Law is a top compliance risk as it currently stands. He believes that eliminating ambiguities is the first step in this reform. There are no clear or positive answers with Stark Law because of the three dozen exceptions. Fee-for-service cannot be properly converted to value-based healthcare. It needs to be modernized in order to be a success. Stark penalties need to be more reasonable, he said. Minor violations can be staggering and make barriers even when there are valid defenses. Lastly, he mentioned that reforming Stark Law to allow for innovative payment arrangements would be beneficial. Hospitals and physicians need to work together to improve patient outcomes. Because of the rigid hospital approach at the moment, this cannot happen. Reforming Stark Law will allow innovative relationships and further the goals of MACRA.

AAOS has worked vigorously to protect the In Office Ancillary Service Exception (IOASE) to the Stark Law noting that self-referral does not lead to overutilization and had commissioned a study to prove this point.