What some providers say they find particularly galling about Stark II is that the Centers for Medicare and Medicaid Services' Medicaid/Medicare reimbursement policy is moving toward a “pay for performance” standard. This means that hospitals and others who receive reimbursement from Medicare/Medicaid will be reimbursed only as long as they can prove with data that they meet the standard of care. As Donna Guadagnoli, president, Colorado Alliance for Continuing Medical Education, Denver, says, “It is somewhat contradictory, isn't it? Provide quality patient care, but CMS is going to create barriers for physicians to receive CME — which will assist them in delivering quality patient care in accordance with the standards of practice … because CMS believes CME is of no benefit to the hospital, and therefore a gift, like golf balls, for physicians. So CMS delivers a bunker shot to CME providers, and leaves it up to us to figure our way out of the sand trap.”