Physician groups lay out their case for Stark reform
In their letter to Congressional leaders, officials at the Englewood, CO-based Medical Group Management Association (MGMA) and the Arlington, VA-based American Medical Group Association, requested that the following specific changes be made to the Stark II self-referral laws, according to Anders Gilberg, government affairs field representative at MGMA:
"1. That Congress remove the compensation arrangement’ provision of the law. Section 1877 of the Social Security Act prohibits certain referrals where a physician has a financial relationship with the entity to which a patient is referred. Financial relationship’ is defined as either an ownership or investment in the entity’ or a compensation arrangement.’ When applied to the practice of medicine for medical groups, the inclusion of this prohibition as it relates to compensation arrangements is extremely confusing and unworkable.
"2. That Congress clarify the definition of group practice’ to ensure that HCFA follows the intent of the statute. This is the only place in the entire Medicare statute in which the term group practice’ is defined. Thus, it is very important that the definition be clear and capable of fair and uniform application to the broad spectrum of physician group practices."
The groups’ two main concerns with the existing definition are as follows:
"Compensation Test: The compensation test within the definition of group practice highlights the unfairness with which the statute and proposed regulations treat physicians practicing in different settings. For example, using the law’s in-office ancillary exception,’ a single specialty group of internists would be able to retain 100% of the compensation derived from the provision of designated health services. The same physicians practicing in a multi-specialty setting, however, would be required to bring those same revenues up to the level of the entire group and share them as profits’ with all members of the multispecialty practice. "Other Standards: The law currently authorizes the Secretary to add by regulation and without limitation, any other standards to the definition of group practice,’ above and beyond those detailed in the legislation. This open-ended delegation defeats any kind of regulatory certainty for group practices and invites regulatory intrusion into the basic structure and operation of thousands of private practices throughout the country."A Stark time line
1989: Original "Stark I" legislation passed, dealing with physician self-referrals to clinical laboratories.
1994: "Stark II" legislation expands the existing law to include a myriad of prohibited "designated services" commonly provided in physician offices, such as X-ray, ultrasound, physical therapy, and chemotherapy.
1995: "Stark II" amendments included in the Balanced Budget Act of 1995. Physician groups supported the amendments, designed to clarify certain issues in the law, but President Clinton vetoed the bill to which they were attached.
1998: The Health Care Financing Administration publishes proposed rules Jan. 9, 1998, for implementation of Stark II. HCFA indicates it could take "a few years" to issue final regulations.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content