Some leaders feel that Stark law and anti-kickback statutes, once intended to safeguard Medicare dollars, are now having an unintended effect: pushing active physicians out of healthcare leadership.
Harry Severance, MD, adjunct assistant professor at Durham, N.C.-based Duke University School of Medicine, joined Becker’s to discuss this impact.
Editor’s note: This response was edited lightly for clarity and flow.
Dr. Harry Severance: Another way in which Stark law and anti-kickback statues now hurt patients and physicians is that, in an era of increasingly corporate/equity run and increasingly vertically and horizontally expanding health systems, we see that these organizations are avoiding the placement of clinically active or affiliated physicians, nurses or other providers on their senior decision-making boards. (Yes, some healthcare corporate entities, such as so-called “non-profit” chartered facilities, may still be required, by various regulations, to have some clinically licensed members seated on their boards. But if you dig deeply, you will find that these seated members are almost always retired from clinical practice and have no current or recent clinical practice affiliations).
By avoiding any seated board members with active clinical practices or affiliations, these healthcare entities believe that they encounter less risk of running afoul of Stark law or anti-kickback regulations in their management decisions. (In reality, many actions that, in clinical practice, have been declared Stark or kickback violations, are common, normal and legal practice in other forms of business enterprise.) One difference is the involvement of Medicare dollars and a perceived opportunity for “directing” physicians or other clinicians to “double dip” through the complicated regulations of the clinical billing process, or to “kickback” by preferentially purchasing further services from themselves, their partners, or their company!
But, Stark laws and anti-kickback statutes were written in a bygone era when physicians ran (and frequently owned) hospitals, clinics and other healthcare enterprises. That era is now long gone, and the vast majority of physicians are now employees.
This absence of “hands on” clinical input, thus lack of understanding of current clinical workplace and patient conditions leads to a status where these senior diction making boards are increasingly isolated and distant from the realities of clinical practice, yet are making ongoing clinical decisions and directives about the patients, workers (physicians, nurses, etc.) and healthcare workplaces that they now control and manage and the healthcare delivery systems they operate.
This absence almost invariably leads to poorer patient outcomes and worsened clinical workplace and workforce conditions.
