As one partner at my firm puts it, “If it makes good business sense, in the health care business, it’s probably illegal.” As a practicing junior health care attorney it did not take long for me to learn this reality of the regulatory scheme I learned as a law student. As snarky as the sentiment may seem, the restrictions on profit-sharing, referrals, and reduced-cost or free goods and services imposed by Stark and Anti-Kickback laws (while well-intended) can stifle some creative thinking in health care delivery.
What is not always as salient in the daily grind of my practice focusing on transactions and system-level compliance issues, are the ways in which the regulatory scheme can limit a physician’s acts of generosity and kindness. Whether we think our regulations intended to align incentives with cost-effective and quality health care delivery are good, bad or otherwise, I found this article in the New York Times by Abigail Zuger to be a thought-provoking moment of pause to consider how the complex scheme plays out in the day-to-day delivery of primary care and the physician-patient relationship.
by Katie Kraschel
Mitt Romney’s anecdote about the binders of women he relied upon in selecting members of his cabinet when he was Governor has fueled criticism from feminist groups and filled my Facebook feed with a plethora of Halloween pictures featuring costumes depicting his unfortunate choice of words. People generally have an instinctive aversion to being summarized into a page in a loosely bound, plastic-covered book. However, this level of summary and (arguably) downright objectification happens every day when individuals peruse IVF clinic and cryobank catalogs shopping for sperm or eggs. And while many of us worry that a Romney win next week would result in four years of presidential leadership that is clueless and insensitive to the plight of women in the workforce, the ASRM decision to remove the experimental label from oocyte cryopreservation is likely to literally increase the number of “women in binders,” which presents a different set of concerns.
Oocyte retrieval — the process of harvesting eggs that allows a woman to place her age, weight, height, eye color, S.A.T. score, college major, baby picture and perhaps even celebrity look-a-like into a gamete catalog — has long been a topic of bioethical debate and criticism due to the risks associated with the high level of hormones involved in the process and the accompanying high level of compensation frequently offered for women’s eggs. The likely increases in demand and number of oocytes produced presents a unique opportunity to revisit these issues and reconsider what regulations may be necessary to keep all parties involved respected and protected.
Last week NPR covered a story highlighting how medical education is morphing in order to adapt to the unmet demand for primary care physicians driven (at least in part) by the increased access to primary care that will be ushered in under the ACA. It may be surprising to some to learn that many of the most prestigious medical schools like Johns Hopkins and Harvard do not have a primary care program; however, as reported by NPR, medical schools may soon rethink this hole in their curriculum in the face of changing demands upon the health care system and its accompanying incentives for young physicians to enter primary care. Mount Sinai School of Medicine is leading the way in this regard by launching a new department of family medicine in June.
Intuitively, changing the medical education system to produce more primary care physicians will further goals of the ACA by increasing access to primary care, and therefore improving overall public health and diminishing cost by decreasing emergency room care for conditions that could have been treated less expensively or avoided altogether by increasing access to preventative services. These are the arguments we’ve heard repeatedly by the champions of the ACA and by the Obama administration, particularly through its vision for the Prevention and Public Health Fund which was intended to bolster the pipeline of primary care physicians before being gutted earlier this year.
We’re excited to introduce and welcome Katie Kraschel to our blogging community as a regular contributor.