If this test is not met, a number of criteria must be met, including disclosure to the patient, advice regarding alternative facilities, and provisions that the professional not be required to make referrals, that the return on the investment not be tied to the volume of referrals, that internal utilization review programs be established and that each referral must be in the best interests of the patient. Physician organizations that contract directly with employers or third-party payors to provide health care services are included in the definition of a business entity to the extent referrals are made between participating members or the physician organization. This would enable referrals to take place between separate practices within a nonintegrated physician organization, such as an IPA, without violating the law precluding referrals to another business entity. Whether this or a similar bill will be enacted into law can only be speculation at this time. That effort must be left to the lobbyists, who will need active assistance from physicians.
Opposition is anticipated.
The law applies only to health professionals, not hospitals, other health care facilities or organizations. The current state of this law in Michigan, however, is intolerable. You are correct that the federal Stark legislation excludes ambulatory surgical centers from its coverage. In fact, the federal legislation has multiple safe harbors and exceptions. Physicians can carefully craft their referral arrangements to fit within the federal legislation governing Medicare and Medicaid, only to find that, under current Michigan law, no referrals to entities in which the physician has a financial interest are allowed.