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INSIGHTS FROM THE BDO CENTER FOR HEALTHCARE EXCELLENCE & INNOVATION

Stark Overhaul Could Boost Value-Based Care,

Increase Tech’s Healthcare Opportunity

Changes Would Require Providers to Have Clear Data Ethics Framework

Healthcare organizations have already ized not only for their own um—must make data
turned to tech giants like Amazon, Among healthcare execu- patient outcomes, but also ethics an important part of
Microsoft, Google and Apple for their tives, clinical leaders and cli- those of their partners in the conversation.
cloud storage services to more effective- care delivery. To succeed in Shifting from a focus on
ly store and analyze health and other nicians at organizations such an environment, it how personal data can be
data, with the goal of improved care directly involved in care becomes critical for organi- used to better improve
outcomes and product innovation. delivery: zations to partner with, and patient outcomes to how it
Doing so is critical to their survival in • 42% expect Amazon to refer patients to, organiza- should be used is key.
an industry increasingly being reim- tions with strong outcomes, Providers can start that
bursed based on quality of outcomes have significant impact on and to be able to track and conversation by establish-
rather than quantity of services. healthcare by 2021 analyze those outcomes. ing a data ethics frame-
For hospitals—whose traditional rev- • 27% say Google will have However, in their current work. Key considerations
enue streams are coming under fire significant impact on the forms, Stark Law and the include:
from all directions—analyzing patient Anti-Kickback Statute, pro- BY VENSON WALLIN, 1. Clearly defining value-
data correctly for the purposes of industry by 2021 hibit: CPA based arrangements and
research and development and • 22% say Apple will have • The referral by a physi- their benefits: Be clear
improved care outcomes can be a life- significant impact on the cian of a Medicare or about what you’re trying to
line. Big tech companies, sensing the Medicaid patient to an organization if achieve through the arrangement, what
opportunity data storage represents in industry by 2021 that physician has a financial relation- issues you’re trying to solve and for
healthcare, are already fighting for dom- ship with that organization which patient populations you’re trying
inance in the industry. *Source: BDO/NEJM Catalyst • The exchange of anything of value to to solve them.
Recently proposed updates to the Buzz Survey influence the referral of business reim- 2. Develop a transparent program that
Anti-Kickback Statute and Stark Law, bursable by federal health programs holds your organization and partners
from the Office of Inspector General OIG’s and CMS’ proposed overhauls, accountable for the use of your patient
(OIG) and Centers for Medicare & Tech’s Opportunity released on Oct. 9, are aimed at encour- and health data: Be transparent about the
Medicaid (CMS), respectively, would We expect the proposed overhauls of aging more providers to transition from use of personal data and take accounta-
make analytics an even more important healthcare’s anti-corruption laws to fee-for-service care models to value- bility to protect it. This includes giving
lifeline for providers—and in the unleash a wave of value-based contracts based ones by relaxing certain compli- your patients knowledge of the data
process, expand tech’s influence in in healthcare. This will open a new win- ance barriers to doing so. The overhauls you’re collecting and how it will be used.
healthcare. This would require provider dow for tech companies in the areas of would add new safe harbor protections 3. Use data proportionate to your
organizations to shift from thinking documentation and analytics. under the Anti-Kickback Statute and cre- value-based arrangements: Only use the
about how patient data can be used to Under value-based contracts, organiza- ate new, permanent exceptions to Stark minimum amount of relevant data neces-
how it should be used. Law for value-based arrangements made sary to achieve and demonstrate the
tions are financially rewarded or penal-
in the interest of better care coordination arrangement’s specific results. Before
and improved patient outcomes. starting the arrangement, determine the
For example, CMS’ proposed excep- types of data you and your partner need,
tions for compensation arrangements the source of it and how you will receive
under Stark Law include one that would it.
apply to a value-based arrangement
where a participating entity has, during Understand Data Limitations
the entire period of the contract, This means understanding the source
“assumed full financial risk from a payer of your and your partner’s data, includ-
for patient care services for a target ing metadata, what processes are in place
patient population.” to maintain the integrity of your data,
Being able to accurately document and and whether caveats will be necessary to
analyze sometimes disparate financial future policies or procedures. Providers
risk under such arrangements—and with the most accurate documentation
show how those arrangements are and data analytics—executed under clear
indeed benefiting target patient popula- data ethics frameworks—will thrive
tions through improved outcomes—will under the future value-based care state
be key for providers to manage risk. and be best positioned to manage com-
More broadly, the quality of the data that pliance risk.
providers collect under value-based con-
tracts, and how they evolve their care Venson Wallin is CPA, Managing Director,
models according to the stories the data at The BDO Center for Healthcare
tells, will dictate the success of value- Excellence & Innovation.
based care.
Contact:
Balancing Data Analytics with Alfredo Cepero, Managing Partner
Data Ethics 305-420-8006/ acepero@bdo.com
At the same time, as the use of data
analytics and documentation becomes Angelo Pirozzi, Partner
even more important to healthcare 646-520-2870 / apirozzi@bdo.com
providers, they—along with their part-
ners and tech vendors on the continu-

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10 January 2020 southfloridahospitalnews.com South Florida Hospital News