Law and Policy Paper:
Stark Law
Many laws and policies that are passed into legislation focus on the ever-important topic of healthcare. From the Health Insurance and Accountability Act of 1996 (HIPAA) to the Patient Protection and Affordable Care Act (commonly called the Affordable Care Act [ACA]) of today, healthcare is an issue that will forever be in the forefront of our societal concerns. However, the law I chose to discuss here is the Limitation on Certain Physician Referrals, more commonly known as the Stark Law. The Stark Law is of specific interest to me because it has had an extensive impact on specialist physicians, particularly orthopaedic surgeons as the law was unambiguously tailored to inhibit certain referrals by orthopaedic …show more content…
More specifically, it is a law that “governs physician self-referral for Medicare and Medicaid patients” (StarkLaw.org, 2008). Essentially, the Stark Law prohibits physicians such as orthopaedic surgeons from referring their Medicare and Medicaid patients to “designated health services” (DHS) if said physician has any kind of financial relationship with that entity. As defined by Stark Law, a DHS refers to: clinical laboratory services; physical therapy services; occupational therapy services; radiology (including magnetic resonance imaging, or MRI); computerized axial tomography scans (CAT Scans); ultrasound services; radiation therapy services and supplies; durable medical equipment and supplies; prosthetics, orthotics, prosthetic devices, home health services and supplies; outpatient prescription drugs, inpatient and outpatient hospital services; and parenteral and enteral nutrients, equipment, and supplies. As outlined by subsection (h)(5) of 42 U.S. Code § 1395nn, a financial relation includes “ownership, investment interest, and compensation agreements” (Wikipedia, 2008), meaning that the physician cannot make the referral at all if they will profit from it in any …show more content…
The Stark Law attempts to deal with the ethical issue of physicians making more money by referring Medicare and Medicaid patients solely to designated health services where the physician holds financial stake(s). In special cases where the physician is not prohibited from referring a patient to a designated health service where the physician holds financial interest, the Stark Law requires the physician to notify the patient of said financial interest in addition to providing the patient with the names of five different alternative providers of a designated health service. The patient is then allowed to choose their provider out of the six options (Merritt, 2013). Looking back at the Code of Medical Ethics and Professionalism for Orthopaedic Surgeons, Standard III. B. (states that if an orthopaedic surgeon has a financial or ownership interest in any medical goods provider or health care facility, the surgeon must inform the patient of this financial interest) is at the forefront of this law. It is extremely apparent that when constructing the Stark Law, the ethical codes of physicians were taken into consideration. The Stark Law is not at odds with the ethics of physicians – it is actually keeping physicians accountable to follow the code of ethics that they had sworn to follow when they entered the profession. The Stark Law is an example of a law that has successfully found the balance between legality and
Stark Law
Many laws and policies that are passed into legislation focus on the ever-important topic of healthcare. From the Health Insurance and Accountability Act of 1996 (HIPAA) to the Patient Protection and Affordable Care Act (commonly called the Affordable Care Act [ACA]) of today, healthcare is an issue that will forever be in the forefront of our societal concerns. However, the law I chose to discuss here is the Limitation on Certain Physician Referrals, more commonly known as the Stark Law. The Stark Law is of specific interest to me because it has had an extensive impact on specialist physicians, particularly orthopaedic surgeons as the law was unambiguously tailored to inhibit certain referrals by orthopaedic …show more content…
More specifically, it is a law that “governs physician self-referral for Medicare and Medicaid patients” (StarkLaw.org, 2008). Essentially, the Stark Law prohibits physicians such as orthopaedic surgeons from referring their Medicare and Medicaid patients to “designated health services” (DHS) if said physician has any kind of financial relationship with that entity. As defined by Stark Law, a DHS refers to: clinical laboratory services; physical therapy services; occupational therapy services; radiology (including magnetic resonance imaging, or MRI); computerized axial tomography scans (CAT Scans); ultrasound services; radiation therapy services and supplies; durable medical equipment and supplies; prosthetics, orthotics, prosthetic devices, home health services and supplies; outpatient prescription drugs, inpatient and outpatient hospital services; and parenteral and enteral nutrients, equipment, and supplies. As outlined by subsection (h)(5) of 42 U.S. Code § 1395nn, a financial relation includes “ownership, investment interest, and compensation agreements” (Wikipedia, 2008), meaning that the physician cannot make the referral at all if they will profit from it in any …show more content…
The Stark Law attempts to deal with the ethical issue of physicians making more money by referring Medicare and Medicaid patients solely to designated health services where the physician holds financial stake(s). In special cases where the physician is not prohibited from referring a patient to a designated health service where the physician holds financial interest, the Stark Law requires the physician to notify the patient of said financial interest in addition to providing the patient with the names of five different alternative providers of a designated health service. The patient is then allowed to choose their provider out of the six options (Merritt, 2013). Looking back at the Code of Medical Ethics and Professionalism for Orthopaedic Surgeons, Standard III. B. (states that if an orthopaedic surgeon has a financial or ownership interest in any medical goods provider or health care facility, the surgeon must inform the patient of this financial interest) is at the forefront of this law. It is extremely apparent that when constructing the Stark Law, the ethical codes of physicians were taken into consideration. The Stark Law is not at odds with the ethics of physicians – it is actually keeping physicians accountable to follow the code of ethics that they had sworn to follow when they entered the profession. The Stark Law is an example of a law that has successfully found the balance between legality and