Stark law settled a record-breaking $9.2 million in voluntary self-referral disclosure settlements in 2022, and many physician leaders have experienced obstacles stemming from Stark law policy.
Here are five physicians' thoughts on Stark law shared with Becker's in the last two years:
Taizoon Baxamusa, MD. Orthopedic Surgeon at the Illinois Bone & Joint Institute (Barrington): As CMS really pushes to reimburse value-based care rather than traditional fee for service, our focus has really been at reducing costs for a diagnostic episode. We are best able to control these costs through our relationships with freestanding ambulatory surgical centers and home health agencies. Reducing the regulatory burden of fear of Stark violations would streamline the provision of care rather than money spent on administrative tasks.
Jayesh Dayal, MD. Anesthesiologist at White Flint Surgery (Rockville, Md.): While most ASCs are organized around single specialty MDs, and this has its advantages, a very underutilized model for phenomenal growth in the volumes of your ASC is the multispecialty MD group model, where MDs of various specialties and primary care MD groups coalesce under the same tax ID and neutralize the "referral" hurdle — there are still anti-kickback and Stark law restrictions on "per tick" compensation formulas, but most lawyers can draft language in corporate compliance rules to avoid these. This way, everyone has skin in the game and high volumes of all kinds of procedures, small ticket or large ticket ones, make the center super efficient economically, as the small ticket surgeries pay for the overheads and break even, and the large ticket surgeries go directly to the profit center. Obviously it is easier said than done, as getting primary care MDs to participate in anything is harder than herding cats, but when, and if, they do come around and acknowledge the paradigm shift in the conservative treatment versus early surgery risk-benefit balance tilting in favor of outpatient surgery advances, it can work wonders.
David Hardin, MD. Chief of Medical Innovation at Healogic (Denver): I wish CMS would decrease the burden for physician-owned enterprises under Stark and Affordable Care Act prohibitions. With removal of physicians from healthcare investment, we have seen quality and patient care suffer with costs continuing to rise. This is worst in hospital services, as the largest sector of spending for healthcare. Data has shown physician-owned hospitals to be better for both patient care and costs of care.
Joseph Sewards, MD. Chair of Orthopedic Surgery and Sports Medicine at Temple University (Philadelphia): I think the recent exemption in the Stark law for health systems and hospitals to be able to provide mental health services to physicians is what I have my eye on. I don’t know of any hospital that was withholding those essential services for fear of violating Stark, but anything that removes any barriers to access mental health services for physicians is a huge step. There already are enough barriers out there, and physician burnout and other signs of deteriorating mental health/wellness is getting to be a problem that is quickly getting out of control.
Harry Severance, MD. Adjunct Assistant Professor at Duke University School of Medicine (Durham, N.C.): Congress must be pressed to better modify the Stark and anti-kickback laws that prevent clinically practicing physicians from running hospitals.