Organized medicine groups line up against proposed Stark law changes

Citing the need for patient access to critical services and other concerns, the American Medical Association and 31 other organized medicine groups and associations representing practice administrators stated their strong opposition to federal legislation that would give more teeth to the physician self-referral law.

House lawmakers introduced the bill after recent federal audits showed an increase in the rate of self-referred services. Groups representing several specialties have disputed the conclusions of the audits.

The AMA and the other organizations, including the American College of Cardiology, the American College of Gastroenterology and the American College of Surgeons, oppose what they see as efforts to push patients to seek care in unfamiliar settings that could prove to be more expensive.

“If enacted, this bill would limit access to lifesaving services for many patients and stifle new innovative reforms already under way to improve care delivery and quality improvement,” the groups’ Aug. 12 letter stated. “It would raise the costs to Medicare beneficiaries and the Medicare program by driving patients to more costly facilities, thereby requiring additional expenditures.”

Exception targeted

The physician self-referral law, also known as the Stark law after the 1989 authorizing legislation’s sponsor, initially prohibited doctors from ordering lab services from entities with which they have a financial relationship. The law later was expanded to prohibit physicians from referring Medicare patients to receive certain additional services when there is a direct or indirect financial link. These services include home health, prescription drugs and hospital services.

However, the Stark law includes an in-office ancillary services exception. The new legislation introduced by Rep. Jackie Speier (D, Calif.) would prohibit advanced imaging, anatomic pathology, radiation therapy and physical therapy services from taking advantage of that exception. Proponents of the change have argued that these services typically are not fulfilled during an initial patient visit. The American Clinical Laboratory Assn., the American Physical Therapy Assn., the American College of Radiology and others support the legislation.

“The expansive use of the … exception by physicians in a manner not originally intended by the law undercuts the purpose of the law and substantially increases costs to the Medicare program and its beneficiaries,” APTA said in a statement.

Physicians have instituted measures to ensure that self-referred services provided under the exception are appropriate and medically necessary, the AMA letter stated. For instance, organized medicine groups and other entities have developed appropriate use criteria and clinical decision support tools to assist physicians.

“Integration of these medical services facilitates the development of coordinated clinical pathways, improves communication between specialists, offers better quality control of ancillary services and enhances data collection — all of which improves patient care and maximizes efficiencies,” the letter stated. “In addition, in-office patient access to these services can facilitate immediate diagnosis, physician communication with other members of the care team, and rapid, appropriate treatment of the disease condition.”

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