The Trump Administration continues to pursue its episodic health care reform agenda despite setbacks in the effort to dismantle Obamacare.

The latest: Proposals from Trump's Department of Health and Human Services that would ease restrictions on how physicians can collaborate with other medical professionals and health care facilities without running afoul of fraud and kickback restraints currently in place.

The proposed reforms are in line with Trump's adoption of the value-based care model, where health outcomes are the focus rather than access to or the sheer number of services available to patients. Under value-based care, physicians work closely in tandem with patients and other providers to manage a patient's full health care spectrum. They are compensated based primarily on health outcomes rather than services rendered.

The reforms address legislation put in place that targeted nepotism and self-dealing by health care professionals and providers within the health care system. For instance, one of the reforms sought by Trump would remove some restraints on self-referrals within the health care system, a practice that had become the focus of considerable criticism in the past, as physicians referred patients to specialist clinics in which they held an undisclosed financial interest.

The proposed rule change, "Modernizing and Clarifying the Physician Self-Referral Regulations," is designed to create "exceptions to the physician self-referral law for certain value-based compensation arrangements between or among physicians, providers, and suppliers."

Among the exceptions:

Arrangements where "a physician receives limited remuneration for items or services actually provided by the physician;"
An exception for donations of cybersecurity technology and related services;
An amendment to the existing exception for electronic health records (EHR) items and services.

"This proposed rule also provides critically necessary guidance for physicians and health care providers and suppliers whose financial relationships are governed by the physician self-referral statute and regulations," the proposal states.

The second rule proposal, described as a key piece of Department of Health and Human Services' Regulatory Sprint to Coordinated Care program, would redefine existing anti-kickback laws by providing "safe harbor protections under the Federal anti-kickback statute for certain coordinated care and associated value-based arrangements between or among clinicians, providers, suppliers, and others that squarely meet all safe harbor conditions."

Additionally, it would relieve physicians of liability for offering certain "inducements" to patients to improve their health. One example offered by the Administration was the free distribution by a provider to a patient of a wrist watch that helps patients self-monitor their health.

In part, the proposed changes support Trump's efforts to support better diabetes outcomes. The changes would make it easier for patients to receive in-home dialysis, a particular Administration goal, by giving dialysis providers the go-ahead to offer free or discounted telehealth technology to dialysis patients.

The Administration said its intent is not to strip away all sanctions against health care kickbacks and self-dealing, but to reform those protections where the restraints had gone so far as to negatively affect patient health outcomes. Final versions of the proposals have yet to be published in the Federal Register.

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Trump proposals would ease physician kickback, fraud restraints

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