“Care Coordination” and “Value-Based Care” sound good, but leave it to DC and the managed-care cartels to turn innocuous sounding phrases into ideas that chiefly impose more top-down control and red tape instead of improving patient care.
Apparently the federal Anti-Kickback Statute (AKS) stands in the way of Big Medicine’s “coordination” to trap patients in-network and ensure that no health care dollars leak out of network. So efforts are underway to create new “safe harbors” to shield—from federal prosecution—participants in “alternative payment arrangements.” Participation in such schemes is often only feasible for large health systems. Moreover, it is detrimental to patient care.
One need look no further than the AKS safe harbor being abused by Group Purchasing Organizations (GPOs) and Pharmacy Benefits Managers (PBMs) to see the potential for harm by new exemptions.
What is really needed are reforms to empower patients to control their care and spending, not more tinkering with the status quo that moves in the opposite direction.
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) is seeking comments on new safe harbors. Comments are due by October 26 at 5pm Eastern; however, if you can submit your comments before Monday, October 22, it will help bolster the efforts of physicians meeting with the administration early next week.
AAPS has submitted comments, but we need your help too. Please help us speak out!
Here’s what you can do.
1) Copy the template comments below:
Comments in Response to OIG-0803-N, Request for Information Regarding Anti-Kickback Statute and Beneficiary Inducements CMP
Thank you for the opportunity to comment on potential modifications and additions to anti-kickback statute (AKS) safe harbors.
I urge OIG to proceed with caution in any plans to expand AKS safe harbors facilitating top-down “coordination of care” and “value based arrangements” that too often consider value to someone other than the patient.
Before considering new exemptions, OIG must meaningfully address and end abuse of the current AKS safe harbor at 42 CFR § 1001.952(j). This safe harbor for Group Purchasing Organizations (GPOs) has unleashed an epidemic of kickbacks in the medical supply chain which has spread into pharmaceuticals through similar abuse by Pharmacy Benefits Managers (PBMs). Physicians Against Drug Shortages estimates that safe harbor enabled kickbacks increase “annual supplies costs by at least 30%, or upwards of $100 billion … and the prices of drugs … by at least $100 billion annually as well.” See http://www.physiciansagainstdrugshortages.com/ for details.
Ultimately, fraud, abuse, and overspending in Medicare stem from the involvement of third parties between patients and their care. Exploring solutions that empower patients to be engaged direct consumers, instead of encouraging payment experiments that increase third party interference and limit patient options and choice, would be a more productive use of HHS time and resources.
2) Visit the comment submission form, paste in the comments, edit them to your satisfaction, and submit. The comment submission form is located here: https://www.regulations.gov/comment?D=HHSIG-2018-0002-0001
Thank you for speaking out on this important issue.