HLC Newsletter

HLC President Tells House Subcommittee Federal Fraud, Abuse Laws Must Be Modernized to Enable Value-Based Healthcare Reforms

Grealy:  Legislative, Regulatory Reforms Necessary to Achieve Greater Care Coordination, Payment Linked to Outcomes Rather Than Volume of Services

WASHINGTON – The president of the Healthcare Leadership Council (HLC) testified before a House subcommittee today that legal barriers are preventing the healthcare system from more rapidly evolving from a fee-for-service system to value-based care.  She called upon lawmakers and regulators to “create an open, unobstructed pathway for value-focused activities that benefit both patients and the system as a whole.”

HLC president Mary R. Grealy testified at a House Energy and Commerce health subcommittee hearing on “Examining Barriers to Expanding Innovative, Value-Based Care in Medicare.”  HLC is comprised of leading companies from all sectors of American healthcare.

In her testimony, Ms. Grealy said the Stark Physician Self-Referral Law and the Anti-Kickback Statute are making it more difficult to achieve “greater integration of services, improved coordination of care with cross-sector collaborations, and payment that is linked to outcomes rather than volume.”  She said legislative and regulatory actions are necessary to keep consumer protections in place while modernizing the laws to accelerate the transition to value-based care.

She said, for example, that hospitals can run afoul of current law by offering physicians performance-based compensation to engage in coordinated care, meet high quality metrics, and save money through the avoidance of unnecessary hospitalizations.  She added, “In fact, in terms of maintaining good patient health, the legal status quo does not even allow physicians to provide patients with a blood pressure cuff or a scale to monitor healthy weight at home.”

Ms. Grealy also said that steps are necessary to achieve further success with alternative payment models like accountable care organizations (ACOs).  In addition to calling for progress in data sharing and interoperability, she said the current ACO structure hampers health provider efforts to better manage a patient’s care.

“Currently, Medicare beneficiaries do not choose to enroll in a particular ACO.  Rather they are assigned to one based on the physician they choose to see,” she testified.  “Thus, the ACO is charged with the responsibility of managing this patient’s care even though the patient is likely unaware they are under that umbrella.”

In her testimony, she also said Congress and the administration should address current restrictions on Medicare reimbursement for telemedicine services which are “essential in more effective utilization of healthcare resources and expanding the reach of health providers.”  As well, she urged steps to optimize the value of the nation’s healthcare workforce, saying “All healthcare professionals must be empowered and rewarded to perform to the top of their professional license and to be valued members of care teams.”