ASC and physician leaders are keeping a sharp eye on Stark law, which has evolved into a complex framework that continues to challenge compliance.
Here are five ASC and physician leaders' thoughts on Stark law:
Shakeel Ahmed, MD. Gastroenterologist and CEO of Atlas Surgical Group (St. Louis): There is a twofold answer here. First, these are very complex laws governing the intricate rules between physicians and designated health services. Unintentional violations are possible by this group of individuals who clearly have no legal background, and even the most minor of these violations can result in severe penalties.
Second, while Stark laws don’t apply to ASCs, certain designated services are very closely associated with the outpatient surgery business, including prosthetic supplies and the lab industry, and there currently is no safe middle ground for physicians to be able to own and have an association with all these facets of the health business without constantly having to balance work and the threat of a misstep.
Lisa Knetsche. Practice Manager of The Spine Center of Central Kentucky (Danville): I have noticed that there are more and more arrests for Stark law violations. It seems that they are targeting physicians. The systems are reducing pay, obstructing prior authorizations and then interfering in ways that physicians can earn money. It is simply another assault on physicians, as the Stark laws do not require intent. I think it is another factor running doctors toward no longer working in the medical field.
Matt Mazurek, MD. Assistant Professor of Anesthesiology at the Yale School of Medicine (New Haven): In the last three years there have been several Stark law revisions, and the American Medical Association has supported these changes. For example, determining whether compensation under a specific arrangement is within fair market value is a requirement for many of the exceptions or safe harbors that may be used under the Stark law or anti-kickback statute. Understanding how FMV is defined is of utmost importance. However, for many physicians, healthcare executives and healthcare valuators, the regulations have historically generated ambiguity surrounding FMV. To minimize confusion, CMS redefined FMV in the Stark final rule to be the value in an arm’s-length transaction, consistent with the general market value of the subject transaction. The various formulas CMS now uses to determine general market value remain complex.
Physicians need to understand the importance of practicing while adhering to the new Stark law changes. The recent rules changes have increased the complexity of financial relationships between physicians and other entities. As an employee, it remains the responsibility of the physician and employer to ensure the contract is compliant. Now, more than ever, hiring legal counsel to examine contracts and other financial arrangements is a necessity to avoid potential legal and regulatory compliance violations.
James McCoughlin, MD. Orthopedic Surgeon at Ivy Spine and Orthopedics (Panama City, Fla.): Stark law legislation has become a hydra that has grown more heads with every attempt by the government to fix a specific ill. At some point the government must admit that its tinkering in healthcare has failed and the government should get out of the healthcare delivery business, and simply be a payer if Medicare or Medicaid avenues of care are to remain. Delivery of actual care should be returned to physicians, nurses and other healthcare professionals with the bean-counters reporting to the clinicians, rather than the reverse.
Thomas Stover, MD. Retired Physician Executive: I think there are a few key changes related to this major change expected from this new White House.
- A hopeful end to proposed cuts on Medicare physician pay rates.
- A possible relaxation of the physician-owned hospital moratorium.
- The potential repeal of much of the Stark law, given the current environment of employed physicians.