Physician, Heel Thyself
July 13, 2009 -- In attempting to reform the U.S. health care system, President Barack Obama and congressional leaders have repeatedly said that controlling costs is as important, if not more, than extending coverage to all Americans.
To do so will mean turning around a decade of political will — under both Democratic and Republican control — to the contrary.
Over the past decade, Congress did little to close exceptions in physician self-referral laws and anti-kickback statutes, laws originally intended to completely bar doctors from referring patients for services in which they had a financial interest.
Health care researchers continually say that exceptions in the law are driving excessive and often unnecessary spending.
While the Obama administration has visibly pursued outright medical fraud and abuse enforcement this year, it really falls to Congress to sew up these loopholes. Most observers say legislators are unlikely to close many of the exceptions they created in 2001 through legislation known as Stark II, named after Rep. Pete Stark, a California Democrat who led the charge for prohibitions on self-referral in legislation — Stark I — that took effect in 1992.
Similar "safe harbors" came in 1987 and additionally throughout the 1990s to protect those in the health care industry from anti-kickback laws Congress first passed in 1972.
Rather than eliminating self-referrals, the exceptions have allowed a system to flourish in which physicians in some states now own almost everything, said Jean Mitchell, economist and professor at Georgetown University Public Policy Institute, who's written extensively on the effects of self-referral loopholes.