Patient choice and proper utilization must be protected.
There is a federal law that prohibits physicians from referring Medicare patients to entities in which they have a financial interest—a practice known as "self-referral." However, this law — known as the Stark law—also includes a loophole that excludes physical therapy services from this important patient protection. Thanks to this exception, physicians can steer patients to physical therapy services that help their own bottom line, even when that facility may not be what the patient would prefer.
Why It Matters
Research has found that physicians with a financial interest in physical therapy initiated therapy for patients with musculoskeletal injuries more frequently than other physicians, and physical therapy clinics with physician ownership provided more visits per patient than nonphysician-owned clinics. This is inappropriate utilization. It erodes patient trust in the health care system and drives up costs.
APTA supports legislation and regulatory changes that would exclude physical therapy services from the in-office ancillary services exception under the Stark law.
Mar 1, 2020 / Position Paper
Additional Referral for Profit Content
Dec 1, 2020 / Review
A set of companion rules addresses value-based arrangements — but ignores problematic loopholes.
Oct 15, 2019 / News
HHS thinks it's time to bring some Stark law provisions up-to-date in ways that accommodate alternative payment models.
Jun 5, 2020 / Comment Letters
The Alliance for Integrity in Medicare -- a broad coalition of medical specialty, laboratory, radiation oncology, and medical imaging groups committed to ending the practice of inappropriate physician self-referral.
Jul 19, 2018 / Comment Letters
APTA Comments to Ways and Means Committee for Modernizing Stark Law to Ensure the Successful Transition from Volume to Value in the Medicare Program hearing.