Becker's ASC Review

8 THOUGHT LEADERSHIP The Stark law dilemma facing physicians By Patsy Newitt S tark law was built to guard against financial conflicts in a fee-for-service world, but as healthcare shis toward value- based care, many physicians say the decades-old framework is creating new friction. Physician leaders told Becker's that the law's strict liability standard, complex fair market value requirements and technical compliance rules can discourage innovation and slow care redesign. Even minor missteps may carry outsized financial and legal risk, they said. At the same time, physicians emphasized that the law's intent remains important. e challenge, they said, is that Stark has not kept pace with how care is delivered today. Five physicians joined Becker's to share their biggest concerns about how the Stark law is affecting physicians and physician organizations today. Question: What concerns, if any, do you have about how the Stark law is affecting physicians and physician organizations today? Editor's note: Responses have been lightly edited for clarity and length. Peter Bravos, MD. Chief Medical Officer of Sutter Health's Surgery Center Division (Yuba City, Calif.): e Stark law was designed to prevent financial conflicts in a fee-for-service healthcare system. While its purpose remains valid, strict liability framework no longer reflects how care is delivered today. Even minor technical errors may trigger mandatory repayment and potential False Claims Act exposure, regardless of intent or patient harm. is creates a significant compliance burden and discourages participation in today's more innovative, value-based care models. Jim Freund. Managing Partner at Physician Transaction Advisors (Madison, Conn.): AI has dramatically increased the number of audits taking place, and we know of several groups that have been adversely impacted. We are aware of two groups whose ancillary testing has fallen outside the industry norm and have been removed from payor plans as a result, even though they are highly reputable and insist that the tests are both necessary and defensible. It is something that groups have to be very aware of and should ensure that they are within appropriate limits. Ahmad Maarouf, MD. CMO of Henry Ford Wyandotte (Wis.) Hospital: In my view, the Stark law served an important purpose when the healthcare system was primarily structured around a fee- for-service model. As the industry transitions toward value-based The multifaceted roles of academic ASCs By Francesca Mathewes L ast year, CMS approved more than 500 procedures for the outpatient setting, representing a huge win for the leaders and physicians in the ASC industry who have advocated for an expanded ASC covered procedures list for years. The win came from years of concerted effort and advocacy on the part of the Ambulatory Surgery Center Association, professional physician and specialty societies and other stakeholders — all working together to overcome significant barriers to data collection and analysis in the ASC space. "We had a spine surgeon in the ASC space who was able to perform a lot of the lumbar fusion codes during the COVID-19 pandemic when CMS created a Hospital Without Walls Program, as that allowed ASCs to expand upon what they could do," Kara Newbury, chief advocacy officer for ASCA, told Becker's. But having this kind of facility-level data on the Medicare population in the ASC industry is difficult to come by — in part because about 30% ASCs still rely on paper charting, making data collection far less efficient. Lisa Ishii, MD, interim president of Johns Hopkins Bayview Medical Center and senior vice president of operations for Johns Hopkins Health System in Baltimore, told Becker's that, as an academic medical center, data collection is embedded in their ASC operations. "That's part of our DNA, the tripartite mission-excellent clinical care, education and research," she said. "We encourage our faculty members to use ASCs as a data collection point. If your area of focus for research is joint replacement surgery, and the majority of your joint replacement surgeries have moved to an ASC, then you need to be collecting your clinical data in an ASC." Dr. Ishii said that in acknowledging that ASCs are the go- to site of service for an increasing number of procedures, Johns Hopkins also recognizes the need to shift clinician training to reflect the reality of the outpatient migration. "If you have moved those procedures out of the hospital and they're now in an ASC, then learners need to be in an ASC," she said. "You're educating the pipeline for future generations, be they physicians or nurses or sterile processing technicians." Within Johns Hopkins' network there are seven ASCs, all of which operate under a single limited liability corporation, Dr. Ishii said. Two are designated as joint replacement sites, while another two operate as cardiology hubs. Dr. Ishii said that this strategic utilization of ASCs allows them to keep programs and staff highly specialized and efficient. "I think for us, because we are a mission-driven organization focused on the tripartite mission, I think we can think of our ASCs as sites for the tripartite mission, which lets us do really cool things that we would otherwise be able to do," she said. n

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