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."