WASHINGTON – The Medical Group Management Association is asking the Centers for Medicare & Medicaid Services to call a “time out” on implementing the latest phase of changes to the Stark self-referral regulations.
The group, representing those who manage physician group practices, took the unusual request of asking CMS to re-examine the rules, saying they’re difficult to follow and obfuscate, rather than clarify, which ventures are permissible under the law.
The Stark laws, named for its initial proponent, Rep. Pete Stark (D-Calif.), are now being republished, with the latest version replacing both the first and second versions of the regulations. They’re intended to govern ventures between physicians and hospitals, remuneration and other financial relationships.
Each version of the regulations has contained more clarifications, and revisions have often added to the confusion. Some relationships that were acceptable in the first iteration of the rules have come under question in subsequent revisions, said Bob Saner, a partner in Powers, Pyles, Sutter and Verville, a Washington-based law firm that is counsel to MGMA.
The third phase of the rules was published last September, but MGMA’a comments were in response to changes included in the inpatient prospective pricing system rules that CMS issued on April 30, which contained further Stark refinements.
The group is asking CMS to review the current Stark laws before making any other changes. “The goal of this review should be administrative simplification,” said the letter, signed by MGMA President William F. Jessee, MD.
Comment letters on regulations usually convey organizations’ requests on particular proposals. MGMA’s request is unusual because it’s pleading with CMS to step back and simplify Stark.
“One reason MGMA filed the letter was the ‘piling on’ effect,” Saner said. “You can never get stability in the program.”
Changes in Stark have forced practices to hire legal counsel to re-examine business relationships, driving up practices’ costs while not improving care. The revisions are frustrating practices that want to abide by the law, but they won’t do anything to slow down practices that want to test the limits of the new regulations or CMS’ ability to enforce them.
“I’ve been practicing law in Washington for 36 years now, and this has just become extraordinarily complex,” Saner said. “We have a tough time explaining it to ourselves, let alone anyone else.”