Skip to main content
Sister Publication Links
  • ESG: THE IMPLEMENTATION IMPERATIVE
Subscribe
  • Sign Up Free
  • Login
  • Subscribe
  • News
    • Current News
    • Providers
    • Insurance
    • Digital Health
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Transformation
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Unwell in America
  • Opinion
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Diversity in Healthcare
      • - Luminaries
      • - Top 25 Diversity Leaders
      • - Leaders to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Digital Health Transformation Summit
    • ESG: The Implementation Imperative Summit
    • Leadership Symposium
    • Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Diversity Leaders Gala
    • Top 25 Women Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Hospital at Home
    • - Workplace of the Future
    • - Digital Health
    • - Future of Staffing
    • - Hospital of the Future (Fall)
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • Data Center
    • Data Center Home
    • Hospital Financials
    • Staffing & Compensation
    • Quality & Safety
    • Mergers & Acquisitions
    • Data Archive
    • Resource Guide: By the Numbers
    • Surveys
    • Data Points
  • MORE+
    • Contact Us
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Law & Regulation
November 25, 2020 03:49 PM

Q&A: Azar and Hargan on how anti-kickback changes will boost value-based care

Michael Brady
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print
    Getty Images
    HHS Secretary Alex Azar

    The Trump administration last week signed off on long-awaited changes to physician self-referral and anti-kickback rules that aim to boost value-based care by making it easier for providers, suppliers and others to work together.

    Healthcare executives have warned regulators for years that providers are hesitant to sign up for value-based arrangements or coordinate care, in part, because they're worried about breaking federal fraud and abuse rules.

    During an exclusive interview with Modern Healthcare ahead of the announcement, HHS Secretary Alex Azar and HHS Deputy Secretary Eric Hargan discussed with reporter Mike Brady how the changes could affect the healthcare industry. Below is an edited transcript.

    MH: Why did HHS decide to change the anti-kickback and physician self-referral rules now?

    Azar: These well-meaning rules are there for a reason: to protect against fraud and self-dealing. And unfortunately, they froze in place a disaggregated care model when we know that what we need is coordinated care built around the patient. And so these reforms will, in a sensible way, enable value-based arrangements that let providers coordinate, let them share risk, let them help patients to improve outcomes.

    Let me give you some examples. If you're a patient at a hospital and you have diabetes, the hospital could contract with a diabetes care management company to provide free diabetes care management devices and services that their patients who are discharged from the hospital to help improve outcomes and prevent readmissions. You could have doctors be able to buy smart pillboxes for their patients or provide smart tablets to enable telemedicine and home-based care. You could have hospitals being able to provide cybersecurity support to physicians that they work with. So very sensible things, none of which we believe increased risk for fraud or self-dealing, but that allow healthcare providers to work together.

    One of the ways to get around these rules is to be the same entity, because when you're the same entity, you don't have an anti-kickback issue. And so inadvertently the Stark and anti-kickback statutes, actually the way they've been implemented, inadvertently created an incentive to consolidation and enhanced provider market power in localized areas. And so we believe that an ancillary benefit of these rule changes is to enable virtual collaboration that is built around the patient without essentially requiring consolidation and common ownership.

    Hargan: I think that people have been waiting for these reforms for decades. Essentially, under the old model and the current model of fee-for-service, you have to provide fraud protection, but we've moved so firmly towards value based models. But now in essence, these regulations are constraining the next development of value-based care. Right now, if you try to build these models, in many ways, you can't without taking risks of either strict liability fines under Stark or possible criminal sanctions under the anti-kickback statute. So that's really frozen, a lot of the experimentation and innovation in this space where hospitals and independent doctors, groups, or medical technology companies could try to collaborate.

    Now we're opening a way for them to do so. We're providing a way for them to build what we're calling a value-based enterprise. That's where two or more entities or persons decide to collaborate with each other. We put guardrails in place. Like they have to have a written arrangement with each other. Somebody has to be in charge of monitoring.

    MH: So obviously these changes have been a long time in the making. I'm wondering how quickly you think these rules could make an impact.

    Hargan: We think very quickly. So there's obviously a 60-day delayed date on the changes. But frankly, at this point, these make clear areas where there are safe harbors for action. Providers could effectively begin changing their conduct immediately because clearly we're not going to be pursuing enforcement on that area. We're hopeful, we're going to get entities to come into the space very soon.

    MH: How did the agencies decide which of the sort of various proposals that were in the proposed rule made it into the final versions and did COVID-19 affect what CMS and OIG decided to include?

    Hargan: Well, the final rule is remarkably similar to the proposed rule. There have been clarifications on areas like medical technology in the proposal. We got a number of comments back from medical technology companies that thought that we hadn't been as clear as we could have. We didn't mean to open the door for places like data analytics programs and for people to be able to use these sophisticated programs to allow coordinated care and sharing of data analytics programs between hospitals and independent physician groups. We added an opening for cybersecurity because neither of the regulatory teams believed that there was any real possibility of abuse of donation of cybersecurity technology.

    So a lot of times it prevents small solo practitioners or small physician groups from being able to share data with the hospital because the hospital would say you've got to have cybersecurity. And they said we won't invest in it. So that's prevented a lot of the ability of data transfer among physicians in hospitals.

    So we're hopeful that's going to result in a lot more ability for patients ultimately to get coordinated care rather than them having to sort of redesign and manage their care at every single place they go. Some of these patients with chronic conditions have multiple places that they have to go for care. They shouldn't have to try to manage their own care. Professionals are available to do this.

    To read analysis of this news, click here.

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    cahill_walgreens_photo_i.jpg
    Walgreens won't sell abortion pill by mail in 20 states
    Copy of lab_i.jpg
    FDA eases restrictions on blood donations from gay men
    Most Popular
    1
    More healthcare organizations at risk of credit default, Moody's says
    2
    Centene fills out senior executive team with new president, COO
    3
    SCAN, CareOregon plan to merge into the HealthRight Group
    4
    Blue Cross Blue Shield of Michigan unveils big push that lets physicians take on risk, reap rewards
    5
    Bright Health weighs reverse stock split as delisting looms
    Sponsored Content
    Daily Dose Newsletter: Sign up to receive a late afternoon weekday roundup of that day’s breaking news and developments in healthcare.
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2023. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • Providers
      • Insurance
      • Digital Health
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Unwell in America
    • Opinion
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Digital Health Transformation Summit
        • ESG: The Implementation Imperative Summit
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Hospital at Home
        • - Workplace of the Future
        • - Digital Health
        • - Future of Staffing
        • - Hospital of the Future (Fall)
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • Data Center
      • Data Center Home
      • Hospital Financials
      • Staffing & Compensation
      • Quality & Safety
      • Mergers & Acquisitions
      • Data Archive
      • Resource Guide: By the Numbers
      • Surveys
      • Data Points
    • MORE+
      • Contact Us
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing