For patients facing low health literacy and significant social determinants of health challenges, navigating the healthcare system can be difficult even under the best circumstances.
But according to Esme Singer, MD, chief medical officer of Philadelphia-based Temple Faculty Physicians at the Lewis Katz School of Medicine, Stark law compliance can add another layer of administrative complexity that slows care coordination and makes it harder for health systems to guide vulnerable patients to needed services.
Dr. Singer told Becker’s that Stark law is limiting her organization’s ability to expand navigation programs for patients who often face significant social determinants of health barriers and low medical literacy.
Dr. Singer said Temple clinicians often know exactly what care a patient needs next and are well positioned to help move that care forward, but Stark law can complicate those efforts by requiring additional compliance-focused workflows.
“We often know what care patients need and we have the ability to help facilitate care, but doing so requires building additional workflows solely to ensure compliance with the Stark law,” she said. “The added layer is administratively burdensome and time-consuming, and in practice it can slow care delivery and make it harder to implement innovative, responsive care models.”
She said many Temple patients face social determinants of health outside the clinical setting that make healthcare navigation especially difficult. Those barriers, often coupled with low healthcare literacy, can make scheduling appointments and coordinating follow-up care labor-intensive for patients to manage on their own.
“Our patients — especially those we serve — really need help navigating care, particularly when things are more complicated, like cancer care or transplant medicine,” she said. “Creating additional tools for us and for patients to overcome in order to comply with a law that may not be applicable in today’s reimbursement landscape just adds layers of time, effort and red tape that don’t need to be there.”
Dr. Singer pointed to situations such as unexpected actionable findings on imaging, where Temple can alert a patient that follow-up is needed, but the next steps can become harder to facilitate because of self-referral concerns.
She said Temple physicians often want to help patients get to the next appropriate step quickly, and in many cases that care would naturally be delivered within the system. But navigating patients too directly to those services can raise concerns about how those actions could be perceived under Stark law.
“We often know what patients need next because we are a healthcare system, so we want to navigate them to that next step,” Dr. Singer said. “Oftentimes these recommendations would be within our system. I can’t easily navigate outside of Temple. Doing that would make things more thorough, more holistic and quicker.”
According to Dr. Singer, physicians must be careful that their guidance is not viewed as steering patients in a way that could be interpreted as self-referral or as conflicting with the law’s intent to prevent improper financial incentives.
“Ultimately, it can become an insurmountable barrier if you’re trying to be cautious,” she said. “There’s no loophole if you want to be fully compliant.”
She said physicians must make clear that patients have the option to seek care elsewhere — a principle she does not oppose — but one that can still create anxiety around regulatory scrutiny and make providers more hesitant to take an active navigation role.
“Physicians must give patients the option to go somewhere else, which isn’t bad in itself,” Dr. Singer said. “But you always worry that could be perceived negatively if the government ever came calling.”
More broadly, Dr. Singer said the law’s original purpose may no longer align with how care is delivered or reimbursed, particularly as health systems increasingly emphasize care coordination, patient support and value-based approaches.
“While I appreciate the original intent of the law, it seems misaligned and antiquated given how care is delivered and reimbursed today,” she said. “Additionally, it seems inconsistent with what our patients actually want, which is to help navigating the medical system. Without support, scheduling and coordinating care on their own can be confusing, time-consuming and is associated with longer delays. This is bad for patients, especially among our vulnerable populations here at Temple.”
