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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:
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.