Stark Law, Elderly Woman in Wheelchair

Is the Stark Law outdated?

The Stark Law has been in effect for more than two decades with the goal of preventing physician self-referral which is thought to drive up cost and unnecessary procedures. Like any law, it has its supporters and critics. Recently, the Centers for Medicare and Medicaid Services (“CMS”) has issued an RFI looking for recommendations “on how to address any undue impact and burden of the physician self-referral law (also known as the “Stark Law”), focusing in part on how the law may impede care coordination, a key aspect of systems that deliver value.”

On the face of it, this law has a great goal: reduce unnecessary tests and procedures as well as cost, but are care providers in turn limited in terms of care coordination? Care coordination is hugely important in order to achieve appropriate, safe and effective patient care. However, if a physician cannot refer to the best provider and coordinate a patient’s care effectively because of a conflict as outlined in the Stark Law, everyone involved loses, most importantly, the patient. While it’s true that no law can satisfy every situation and instance, it is important to get it as “right” as we can.

Both CMS and the Department of Health and Human Services (HHS) are looking for ways to reduce government obstacles that hamper coordinated care efforts. Given that HHS is pushing to “transform the healthcare system into one that pays for value” coordination of care is an incredibly important part of that.

Is it time for a change to the Stark Law based on our new healthcare environment or will reversal of this law create more unnecessary healthcare costs?  

What to do next: What are your thoughts? Should the law be scrapped? Should it be replaced or are there adjustments that can fix the law’s shortcomings?

Your opinion matters and CMS is taking your feedback. Download the RFI form from the Federal Register here.

A blue and orange logo with a sun in the middle.

Sunlit Cove Healthcare Consultants

We provide management and consulting services to help healthcare businesses run efficiently. Navigating the dynamic and complex revenue cycle management is a challenge for many health plans, health care vendors, and providers. Our consulting services are available to assist with your day-to-day operations and provide expertise in growth and change management. We manage all aspects of your enterprise from the development of the revenue cycle management process to the completion of your business cycle.

Related: Policy and Procedure Development and Implementation