APTA Still Working to Improve Self-Referral Law

Emphasis on value-based approaches to care means increased focus

The American Physical Therapy Association (APTA) sent staff and legislators to Capitol Hill last month to encourage lawmakers to take a careful approach to the Stark Law, a prohibition on the practice of physicians referring Medicare patients to specific services in which said physician holds a financial interest.

A July 17 hearing in the U.S. House of Representatives Ways and Means Health Subcommittee saw the Stark Law discussed at length, as legislators were weighing the law’s effect on the ability to create alternative payment models (APMs)—systems that often seek to streamline and coordinate entire episodes of care.

The hearing echoed a recent CMS request for information from the public on the Stark law, and discussed whether there is a need for “revisions or additions to exceptions to the physician self-referral law, and terminology related to alternative payment models and the physician self-referral law.”

The current version of the Stark law includes an exception that allows physicians to self-refer for so-called “in-office ancillary services” (IOAS) that include physical therapy.

“Until [the US Department of Health and Human Services] creates a more level playing field between these different types of providers, physical therapists will be unable to meaningfully participate in Medicare and Medicaid APMs, despite their desire to do so, potentially impeding patient freedom of choice and access to the highest-quality care,” the APTA’s comment letter states.

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