HLC Newsletter

HLC Hill Briefing Spotlights Barriers to Value-Based Care

Saliha Greff, J.D., MPH, Medtronic.

The Healthcare Leadership Council hosted a briefing on Capitol Hill highlighting the need for modernization of healthcare fraud and abuse laws, specifically the physician self-referral (Stark) law and federal Anti-Kickback Statute.  In a time in which different sectors of healthcare must work together in order to provide patients with integrated, coordinated, evidence-based care, these laws are serving as barriers to the transition to value-based healthcare.  Congressional staffers heard from a panel made up of experts representing various health sector perspectives.

Troy Barsky, a partner at Crowell & Moring LLP, gave an overview of fraud and abuse laws, noting they were meant to combat overutilization.  However, these laws were not designed for modern health integration and value-based payments.

Saliha Greff, vice president of commercial law within the Patient Monitoring and Recovery division at Medtronic, described how medical technology companies want to share risk in order to achieve better quality and improved patient outcomes.  She argued that, if all parties share financial risk, the potential for overutilization is limited.  The Anti-Kickback Statute obstructs Medtronic’s efforts to achieve greater affordability for patients and, with it, better outcomes.

Travis Lloyd represented Ascension Health and discussed the need to bypass the patchwork of protection that waivers provide in order to achieve the collaboration and accountability necessary for care coordination.  He also said the penalties associated with Stark Law and the Anti-Kickback Statute are immense and create a risky environment for innovation.