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Stark II rules still need fine-tuning, doctor groups say

Round two: Physicians offer their suggestions on how to further refine the latest version of the self-referral regulations.

By Tanya Albert, amednews staff. June 18, 2001.

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For the most part, physician self-referral regulations that the government issued in January will be less disruptive to everyday practice than expected. But physicians say there are still a few problem areas in the 600-page regulation.

From in-office ancillary exemptions to indirect compensation, some parts of the regulation will need to be fine-tuned for doctors to provide the best patient care possible as they apply the rules in real-world situations, physician groups said.

"There is a tremendous effort for people to work together and provide care, and these rules seem to discourage that," said Bruce Bagley, MD, American Academy of Family Physicians chair. "It tries to keep everyone at arm's length."

Physicians and others had until June 4 to let the Health Care Financing Administration know about the problems they still had with the physician self-referral regulations, known as Stark II. About two weeks before the deadline for comments, HHS had received 81 responses on the regulations. That's a mere fraction of the nearly 13,000 comments the agency received after it asked for feedback on the 1998 proposed regulations that preceded the final rules.

"The clients we represent and the lawyers are pleased HCFA tried to clarify rules and add flexibility," said health care lawyer Patricia Meador, chair of the American Bar Assn.'s health law section. "There are some issues that are unresolved and unclear because the statute is unclear."

Physicians say they want the regulation to be more forward-thinking because it doesn't accommodate medical advances. [...]