June 1998 AAOS Report

Dr. Heckman tells HCFA to drop self-referral rule

Academy president James D. Heckman, MD, in a letter to the Health Care Financing Administration (HCFA), urged the agency to withdraw its proposed rule on physician self-referral, saying that it has added even more confusion to what activities are permissible. Dr. Heckman said, "we request HCFA to make major changes in its approach in order to recognize the many ways patients receive care in an integrated health care delivery system." HCFA's proposed rule does not provide clear, unambiguous guidance for compliance with the "Stark provisions," said Dr. Heckman. "The Academy is greatly concerned about the enormous complexity of the proposal. The over 70 pages of detailed regulation in the proposed rule point to the fact that even experienced health care attorneys and accountants will have difficulty advising their clients on how to safely adhere to the regulation." Dr. Heckman stated the Academy strongly believes that most of the problems being experienced with the "Stark provisions" can be solved with a "common sense" approach to the question of what is a "referral." The Academy strongly believes that HCFA's definition of what constitutes a "referral" is unnecessarily broad and essentially gives preferential treatment to certain practice settings at the expense of others. Instead, Dr. Heckman suggested "that HCFA adopt a standard that those activities that a solo practitioner performs as a customary and integral part of patient treatment should not be considered a 'referral.' This definition should extend to physicians in practice arrangements as well."

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