Cath Lab Digest

• It prohibited a certain type of “under arrangement” contract between hospitals and physician joint ventures;
• It prohibited per click/per unit payments on space and equipment;
• It prohibited transactions that were based on percentage for space and equipment.

One might wonder why there are still privately owned cath labs operating. They can do so, if they are working within the limitations of the Stark Laws. Some facilities have been able to find these exceptions, or work together within the boundaries of the laws. There are a number of exclusions and minute details in these laws that continue to be argued by attorneys.

The Centers for Medicare and Medicaid Services regulate the Stark Laws and advisory opinions with other government agencies, such as the Office of Inspector General and the US Department of Justice, enforcing fines, if necessary. Stark Laws only apply to Medicare/Medicaid patients.

How Private Labs are Affected (and Our Experience)

The Stark Laws have individually affected many cath lab personnel, who have, regrettably, become innocent victims as their jobs have been swallowed up in government bureaucracy when hospitals have legally overtaken private practices. Employees used to have security in the ownership of their companies. Now many physicians have been forced to fight for control to maintain their property and staff. However, many have lost. The employees have become bewildered as their employer is left with little power to preserve an intact company. They watch it become consumed by the larger corporate environment, the hospital.

Most people who work for hospitals are completely satisfied with their employment. They applied for their job by choice. The problem with the type of transition mentioned above is that it is not expected, intended, or designed by both parties with complete equity. The staff is caught in the middle of two corporations (the physicians and the hospital) trying to hammer out the best deal. Through the physicians’ loss, the employees are left with the decision to find alternative work, or accept what is offered through the hospital negotiations. Negotiations have resulted in some staff loss of wages, loss of tenure for paid time off, loss of tenure for 401K, decreases in % of pension plans, starting over with insurance, and the list goes on. They are under a new employer, so they are treated as new staff, even if they have worked with the facility for 20 years. As the transition occurs, the staff may experience the five stages of grief described by Elisabeth Kübler-Ross: denial, anger, bargaining, depression and then, hopefully, acceptance. Like a roller coaster, each day, the emotions are raging. It takes months for most to overcome until they reach resolution. As every team member is working through their emotions on a different level, one can only envision what torment the department is undergoing every day.

In a private lab, employees have had the opportunity to celebrate the best. The physicians have the occasion to bypass the hospital channels that can restrain progress. They are able to make choices for new products in a timely fashion without having to wait for hospital capital expenditures, can provide competitive salaries to retain the best staff in the city, offer access to multiple product lines to offer variety and success in procedures, and substantial rewards for production and cost-cutting measures. These facilities have a shorter chain of command, so the staff feels closer to the top management. This lends itself to a feeling of family and helps them feel less of a “number.”

This environment of accomplishment leads the staff toward:

• Autonomy
• Distinguished facility reputation
• Pride in their work
• Heightened physician relationships
• Sense of entitlement
• Quality unsurpassed
• Substantial bonuses

What’s a Manager to Do? Insecurity During a Transition

During a transition, staff fears the unknown. They believe they will become lost in the masses of the corporate environment. The personal relationship they have had with their physicians is jeopardized. No one can tell them initially if their wages will be cut. There is a dread of job loss.

Working in this corporate environment, where productivity is the bottom line, they sense they will be sent home when the census is low and as a result, will be unable to meet their bills. The unanswered question of floating to other floors looms in their minds. Some apprehensions are irrational, while some are well founded. Regardless of how unreasonable their fears are, thoughts of anxiety and uncertainty well up inside everyone to create a very restless, agitated staff. Until all these questions are answered, there is not much a manager can do except offer moral support.

When the staff is in the midst of this turmoil, no words can pacify them. It is kind to say, “It will be alright,” but no one knows what the future holds. All everyone can do is hold on together and believe in the best outcome.

Try to console to one another, as everyone is riding this wave in concert. Individually, attempt to get out of bed on the right side, so as not to be a bear every day. There will be times that emotions get the best of the team, but don’t hold a grudge. The team is hurting. Give some allowance for this.