If Health Reform is Approved, Many Federal and State Laws Will Need to Change

Other laws also may need reworking, including the Health Insurance Portability and Accountability Act, to facilitate sharing of patient information that improves the quality of their care.

Other federal laws that prohibit kickbacks, self-referral, and other financial relationships between certain types of providers, such as hospitals and physicians, may be obstructions to true health reform as well, Jost suggested.

Medicare is among the worst culprits in preventing efficiency and better quality of care. "Medicare's current 'siloed' payment system (by which drugs, skilled nursing and rehabilitation, physician's office visits and outpatient care are reimbursed from separate funds) does little to encourage positive integration and much to encourage costly and unproductive relationships between professionals and providers," Jost wrote.

"Were Medicare to move to bundled, value-based payments, realignments of relationships within the delivery system could be dramatic. Changes in federal law should be considered to accommodate these relationships."

In particular, he continued, "new safe harbors from the self-referral, anti-kickback, and civil money penalty laws, and possibly new interpretations of the antitrust and tax-exempt organization laws, could expedite positive changes."

Federal laws aren't the only impediments. State-by-state, Jost wrote, corporate practice of medicine prohibitions, certificate of need requirements, and scope-of-practice limitations will deter cooperative arrangements among institutions and practitioners, and discourage more effective use of non-physician providers.

And, in certain states, privacy regulations that supplement those codified in federal law complicate collaborative treatment of patients, he said.

And even if a comprehensive health reform effort fails, or the final product is far less ambitious, "there is still much that federal agencies can do to facilitate private reform."

The Centers for Medicare and Medicaid Services can sponsor demonstration projects that test various concepts for administering its programs. And Congress can give states more authority to regulate health insurance benefits or expand Medicaid coverage to childless adults or unemployed people with incomes below certain poverty levels.

At the very least, Jost wrote, "it is important that we inventory and analyze state and federal laws that will affect reform so that we can proceed intelligently."

Follow Cheryl Clark on Twitter.