The In-Office Ancillary Exceptions - Research Paper Example

Stark Law: The In-Office Ancillary Exceptions Number The In-Office Ancillary Exceptions In general, theStark law outlaws medical doctors from making patient referrals to select health facilities where those practitioners or their immediate relations have pecuniary interests, unless such actions are in line with the exceptions provided under the legal regime. The exceptions apply where: a) a physician provides services via the medical practice; b) the care so provided furnishes select health service where Medicare may be applied to settle the costs, thus translating the medical practice into a Designated Health Services (DHS) facility; c) the medical practitioner is financially associated with the care services; and d) the medical practitioner implements referrals to a care provider for purposes of furnishing the DHS. Physicians and health practices depend on the in-office ancillary services and related medical practice exceptions to the Stark law to permit DHS referrals within the parameters of the practice. Of these, Washlick (2008) noted that the in-office ancillary services exception is most commonly applied because it enables physicians providing various services to: a) make referrals for select DHS within the confines of medical practice; b) inform those DHS to provide the necessary patient care; c) apply Medicare and Medicaid cover to defray the costs resulting from the services; and d) retain and channel the revenues collected from rendering the services within the practice for settling practice expenditure and physician remuneration. These exclusions are therefore of great value to the rendering of patient services and other internal activities. The in-office ancillary services exception As Micklos and Sevell (2004) noted, the in-office ancillary services exception (IOASE) is arguably the most significant allowance given under the outlaw of self-referrals of select health services by medical practitioners. In the recent past, however, renewed attempts to revisit referral rules have threatened the effectiveness of physician practice. For instance, the federal budget for the 2014-2015 financial year contains a number of measures which are intended to enhance a greater level of proper remuneration for the proper rendering of health care under the Medicare platform. The budget is responsive to various recommendations by the Government Accountability Office (GAO) and MedPac that self-referral of simpler services culminates in a higher volume of care when they are integrated with payments for the service fees (Clark, Johnstone, Lynch, & Cardenas, 2004). The Budget seeks to limit the IOASE by permitting only practitioners who meet given undefined levels of accountability to carry out self-referrals of radiation treatments, therapy services, and technology-intensive imaging services such as Computerized Tomography (CT) scan and Magnetic Resonance Imaging (MRI) services. As Washlick (2008) noted, while it is unknown whether, or in what way, these measures will be implemented to the letter, it is apparent that radiation therapy, computerized imaging services and physical therapy might be excluded from the list of safeguards under IOASE. Micklos and Sevell (2004) suggested that physician-owned ancillary services, especially advanced screening imaging, have been subject to criticism from two viewpoints. First, the US’s Upper House’s Finance Committee forwarded requests to the Congressional Budget Office (CBO) for the lifting of the IAOSE exemptions to the Stark Law, because it relates to physical treatment, medical laboratory services, and computerized diagnostic imaging. Then, the GAO released a statement showing that physicians had made excess referrals of computerized imaging services whenever it was established that they had financial interests in the referral facility. Impacts on block leases The statement suggested that the quantity of MRI services recommended during the duration of study rose by more than four-fifths among parties that had recently obtained certifications for in-office advanced imaging services. The number is in sharp contrast to a 12 percent rise for MRI scans among medical practitioners and facilities that do not provide in-office computerized imaging services (Washlick, 2008). In 2010, it was estimated that practitioners who offered internal advanced screening services made about 400,000 referrals in excess for the diagnoses compared to providers that lacked their own in-office computerized imaging services. The sheer number of referrals consumed $109 million in extra Medicare costs. Baumann (2004) argued that while reacting to Senate’s request, which was seeking to limit the application of the regulations, the AAOS suggested that in the event that the CBO registered substantial savings from terminating the IOAS exception, the Lower House could channel those moneys to cover the budget shortfalls facing the health care sector. AAOS requested a direct meeting with the Congressional CBO and advised various stakeholders within the former organization to consult their respective representatives in Congress and voice support for the integrated services approach to care as envisaged in the IOASE. As Micklos and Sevell (2004) indicated when Congress is fixated on perfecting care coordination via the creation of health care facilities and that are accountable, lifting the IOASE exception rules may appear counterproductive. Clark et al (2004) argued that removing the IOASE exemptions would negatively affect orthopedic care seekers because they would lack care services that are sufficient to treat their musculoskeletal diseases. Washlick (2008) said fragmentation of health care services lowers the quality and passes higher costs to the patients. According to Baumann (2004) the in-office imaging services can impact a greater level of patient conformity to treatment programs and better results for orthopedic patients. The capacity to offer in-office ancillary services at an orthopedist’s organization is often a reprieve in itself, especially for persons with musculoskeletal conditions and physical disability. Industry Effects The measures envisaged under IOASE provide no reprieve for services previously rendered by making referrals of physician practices in bad faith. The law has the potential to create massive demystification of ancillary treatment machines and the related services and changes. Moreover, it is expected that countries and other private financiers will follow in the legislature’s footsteps and implement similar rules, which may transform currently feasible referrals and Medicare benefits. As Clark et al (2004) suggested, the new legal regime does not impact Starks uniqueness to rural care providers. Owing to the fact that exceptions is more limited under the IOAS, even making references of physician practices in the non-urban regions may be needed to reorganize their internal mechanisms for the settling of incurred medical costs. Conversely, the law would not change Stark law’s exemption from unilateral “referral” of medical services requested by pathologists, screening radiologists and oncologists, without the input of another practitioner. Notably, this exclusion falls short of safeguarding the medical practitioner who recommends the consultation, but whose actions will be seen as made in reference to the ancillary service (Baumann, 2004). This is so, regardless of whether the performing doctor is not covered. The regulation could therefore culminate in the reform or in a worse scenario in the form of a degeneration of conventional referral and performing physician culture. From the organizational standpoint, however, the long-term benefits of IOASE would not be a preserve of a few physicians who outsource important services to genuine organizations. Regardless, health care facilities and other care providers that offer precise non-ancillary services would also be beneficiaries of the legislation. Interestingly, patient-centered medical care under IOASE will be delivered in a more affordable, non-hospital environment (Washlick, 2008). The changes imply that the IOASE has been undergoing gradual evolution over time and should be implemented further with minimal modifications which limit corruption to make it work. The government should steer clear of unsubstantiated claims presented by biased investors who seek to stay entrenched monopolies in the provision of healthcare services. These groups inaccurately claim that removing this important legal provision will yield more savings for the government’s Medicare plan. But the truth is that self-referrals benefit physicians who want to make more money than they deserve by using their personal connections, hence should stop. Conclusion Generally, the IOASE to the Stark law permits medical practitioners such as urologists to provide informed patients systematic, efficient, and top quality services. Availing to patients, care services such as technology-based imaging diagnoses, medical and anatomical laboratory screenings, and radiation therapy to the sick enables urologists to balance their high expertise and comprehensive knowhow of the medical history of a sick person to recommend an appropriate treatment plan that will be rolled out without any hitches. In such situations, patient compliance would develop and the likelihoods for faster, thus enhancing more effective treatment benefits. References Baumann, L.A., (2004). Learning to Live with Stark II/ Phase II Regulations. Dennis Barrys Reimbursement Advisor, 19(10), 1-12. Clark, D.S., Johnstone, D.M., Lynch, J.E., & Cardenas, G.A., (2004). Final Stark II Phase II Regulations: Not Likely the Last Word but a Step in the Right Direction. Journal of Health Care Compliance, 6(4), 5-12. Micklos, J., & Sevell, R., (2004). Is the Stark Laws Whole Hospital Exception Destined to Become Old News? Journal of Health Care Compliance, 6(2), 28-30. Washlick, J.R., (2008). Examining the impact of the new Stark rules on joint ventures. Healthcare Financial Management, 62(11), 48-52. Read More