Are you concerned that the Stark exemptions won’t be upheld?

“As a multispecialty group, we are of course concerned. We refer within our own group because we are able to determine the quality. I know the radiologist; his office is right next door. If there’s a question about the patient, we can look at results together, as opposed to sending the patient to the hospital where I have no idea who is reading films, or their ability.

To me, if I’m referring within my group, it’s no different than a hospital-employed doctor being required to refer to the hospital’s ancillary or other hospital-employed doctors.”

Eric Darby, MD

Newport News, VA

“We have a robust ancillary service line with surgery center, imaging, radiology, and oncology services. If they were to take away physicians’ ability to provide ancillary services and force us to go through a hospital, that would be disastrous for physicians and patients.

The irony is, in a time when we need to be more clinically integrated, and there’s a big shift from volume to value, which is what the Stark law was trying to address, if you’re going to provide higher quality, lower cost, and more accessible care, you have to be able to run ancillary service lines.

Hospitals tend to be higher cost centers. When physicians invest in ancillary services, they have an opportunity and responsibility to provide higher quality, lower cost service than if patients go through a hospital. As we move toward a value-based delivery model, the timing is inappropriate, quite frankly, to shift ancillary service lines to higher cost centers.”

Paul Merrick, MD

Naperville, IL

“Doctors need to be careful to order appropriate services. A lot of special services are not duplicated locally, like radiology, when a physician practices in a rural area.

Increasingly, doctors are going to larger groups, where there is more potential of having financial ties to these facilities. If they were to get rid of the exemptions to the Stark law, they would have to take into account doctors who are employed by hospitals. Would hospital-employed physicians be able to refer to their own hospital facilities? If not, there might be no other facility for patients to have services provided if they live in a rural area. If so, that would give them an unfair advantage over the private practitioner.

I practice in a very broad geographical area. If patients are driving 70 miles to see me, I’m able to let them combine their treatments or services, so they don’t have to make that trip more than once.”

Nathan Ullrich, MD

The Dalles, OR

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