The Stark (II) Truth

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The Stark II law, which just went into effect a few weeks ago, has to be one of the most frustrating documents I ve dealt with in a while. Sponsored by U.S. Congress Representative Pete Stark, the revisions focus on many aspects of Medicare/Medicaid, including potential fraud and abuse on the part of hospitals that have rewarded physicians for referring Medicare/Medicaid patients to them rather than to competing hospitals. These rewards have included sizeable dollar payments per patient, free parking in hospital structures, free meals, free travel, special gifts and now, says CMS, CME falls under the same umbrella. Maybe.

It s all pretty vague: "In many cases, the provision of CME to physicians could constitute a benefit of significant monetary value to physicians. CME may be covered under the non-monetary compensation up to $300 exemption," according to the Federal Register document. The other direct mention of CME in the comments portion of the document is in response to a hospital association s question on benefits that can t fit into the $300 exception, including "Free continuing medical education or other training at the hospital. [The commentator noted that hospitals often obtain educational speakers free of charge, thus enabling them to provide low-cost training.]" The response was: "The free CME could constitute remuneration to the physician, depending on the content of the program and the physician s obligation to acquire CME credits." So it depends on whether it s accredited CME or not?

When I contacted CMS, they weren t about to give me an answer to that question (or my many other questions), saying that "We really can t work in hypotheticals there are so many variations on the facts of the various CME arrangements that it would not be possible [to provide] one-size-fits-all answers." Fair enough, but that still leaves providers especially hospitals in limbo. If they don t comply, they get nailed to the tune of $15,000 per occurrence, according to one attorney I spoke with. But there s no guidance telling you specifically how you can comply.

And why on earth is CME lumped in with holiday gift baskets and parking spaces as a perk? The whole point is to improve patient care: Isn t that what CMS wants? And the Catch-22 is that CMS Medicaid/Medicare reimbursement is moving toward a "pay for performance" standard for reimbursement, meaning that hospitals and others who receive reimbursement from Medicare/Medicaid will only be reimbursed as long as they can prove with data that they meet the standard of care. So let s penalize hospitals and other providers who provide education to physicians so they can do just that?

This makes no sense to me. If you have any information, please post it by clicking the "comment" button below, or e-mail me.

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