Stark law has long served as a guardrail against improper financial relationships in healthcare. But as delivery models evolve, many physicians say the next chapter of the conversation should focus less on whether the law should exist, and more on how it should be adapted.
Physician leaders told Becker’s they are not calling for the elimination of Stark’s protections. Instead, they urge policymakers to modernize the framework to better reflect value-based care, coordinated delivery and today’s operational realities.
Several advocated for clearer safe harbors, more flexibility for ancillary and value-driven services, and protections for good-faith compliance efforts. Others said reform should address the law’s strict liability standard. Without thoughtful updates, they said, the law risks discouraging responsible collaboration and innovation aimed at improving quality and lowering costs.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: If you could see one change to Stark law, what would you like policymakers to consider?
Peter Bravos, MD. Chief Medical Officer of Sutter Health’s Surgery Center Division (Yuba City, Calif.): Focused reform is appropriate. Liability should apply only when clear evidence demonstrates intentional misconduct with a material impact on patient care or program integrity. Moreover, technical violations should be eligible for correction without a disproportionate penalty. These changes would preserve the safeguards against abusive self-referrals while reducing unnecessary compliance risks. Modernizing Stark in this way would ultimately protect federal programs and better align the law with today’s healthcare environment.
Jim Freund. Managing Partner at Physician Transaction Advisors (Madison, Conn.): It is imperative that physician groups be able to perform ancillary services at their own facilities. This improves patient satisfaction and reduces costs in most instances.
Ahmad Maarouf, MD. Chief Medical Officer of Henry Ford Wyandotte (Wis.) Hospital: One important change I would advocate for is better alignment with contemporary healthcare delivery models. Specifically, the law should provide greater flexibility and expanded exceptions that support and encourage value-based, quality-driven care.
Harpreet Pall, MD. Chief Medical Officer of Jersey Shore University Medical Center and K. Hovnanian Children’s Hospital (Neptune, N.J.): I would encourage policymakers to continue advancing modernization efforts that better distinguish between arrangements designed to generate volume and those structured to improve outcomes, coordination and accountability. Expanding clear, practical safe harbors for value-based and quality-driven models, with straightforward operational guidance, would help reduce uncertainty and allow organizations to focus less on regulatory navigation and more on care delivery transformation. The goal should be maintaining safeguards while enabling responsible collaboration that supports population health and system sustainability.
Esme Singer, MD. Chief Medical Officer of Temple Faculty Physicians at the Lewis Katz School of Medicine (Philadelphia): I would ask policymakers to consider modernizing the law to support coordinated and value-based care models and account for “good-faith” compliance leniency. This would help reduce administrative burden and expand access to care.
