Calls to Support Stark Law Reforms Blocked by AMA Delegates

NATIONAL HARBOR, Md. — Private practice physicians argued unsuccessfully for the American Medical Association (AMA) to adopt a policy in support of reforming a blanket ban on physician self-referral during the interim meeting of the House of Delegates on Tuesday.

The Physician Self-Referral Law, also known as the Stark law, makes it illegal for a physician to refer Medicare or Medicaid patients to any entity in which that physician, or an immediate family member, has a financial stake, with certain exceptions.

In a policy statement, the Private Practice Physician Section (PPPS) characterized the law as a “blanket self-referral ban” and blamed its “unequal restrictions” on independent practices for driving increased hospital consolidation, which has led to access problems and inflated costs.

Their resolution specifically called on the AMA to acknowledge these dangers and support “comprehensive Stark law reform.”

On the House of Delegates floor, Daniel Choi, MD, speaking as an alternate delegate for the PPPS, urged his colleagues not to refer the policy back to the Board of Trustees, as had been recommended by an AMA reference committee earlier in the meeting due to “factually conflicting testimony.”

“Stark law is an outdated law that unfairly handcuffs physicians from providing integrated care and prevents physicians from competing fairly with hospitals and private equity,” Choi said.

In his own spine surgery practice, the Stark law prevents him from offering specialized physical therapy and bracing for patients internally, while hospitals and private equity firms are free to self-refer, he noted.

“We have allies in Congress who are willing to reform Stark, but we need the AMA to take a strong stance on this,” Choi said.

Krishna Channa, a regional medical student delegate from Connecticut, speaking on his own behalf, also urged support for the resolution and Stark law reforms. He argued that the law, despite good intentions, “has inadvertently limited access to essential patient care, especially for our most vulnerable populations, like the elderly, disabled, and those with multiple health conditions.”

These “crucial care coordination responsibilities” now fall back on already over-burdened patients, Channa said.

Mohammad Ibrahim, DO, a family practice resident and delegate from the Michigan State Medical Society, speaking on his own behalf, said he hopes to one day open his own private practice, though he noted that the uneven playing field in healthcare threatens these ambitions.

“Today, hospitals are eating up practices all around us … and guess what? They don’t play by our rules,” he said.

For the minority of family physicians who remain in private practice — roughly 70% are employed — the Stark law forces them to make referrals to hospitals “miles away,” he added. Meanwhile, it’s the private practice physicians who are willing to work in rural areas, neglected by large hospital systems.

“My future is in literal jeopardy,” Ibrahim said. “We need to jump on this resolution. We need to fix the issue … and increase access to care in rural areas.”

However, Gunjan Malhotra, MD, a delegate for the American College of Radiology, offered a different point of view.

“We agree that corporations should be held to the same ethical standards as physicians,” she said, but the “particular language” of the proposed policy raised “AMA ethical policy concerns” and questions related to patient safety.

“As written, this resolution would divide our House,” she added, requesting that the House follow the reference committee’s recommendation to refer the resolution to the AMA’s Board of Trustees, “so we can study how to best accomplish this task in an ethical manner.”

Ultimately, the House voted 329-120 in support of referral. A second vote was taken due to concerns regarding voting instructions, but the end result was the same.

Please enable JavaScript to view the comments powered by Disqus.