Becker's Spine Review

25 PRACTICE MANAGEMENT A Deeper Dive Into CMS' Proposed Stark Law Modifications: 6 Key Points By Ayla Ellison C MS released a proposed rule earlier this month that would update the Medicare Physician Fee Schedule for calen- dar year 2016. e proposed rule contains a number of new policies, including Stark Law modifications. Here are six key takeaways from the proposed rule regarding Stark Law. New exceptions 1. Stark Law prohibits a physician from making referrals for certain designated health services payable by Medicare to an entity with which the physician or an immediate family member has a financial relationship. However, there are several exceptions to the rule. 2. CMS proposes establishing a new Stark Law exception to permit hospi- tals, federally qualified health centers and rural health centers to provide remuneration to physicians for re- cruiting nonphysician practitioners. However, for the new exception to apply a number of conditions must be met. For example, the nonphysi- cian practitioner must be a bona fide employee of the physician, according to a Mondaq report. 3. In the proposed rule, CMS calls for timeshare arrangements with physicians that involve a hospital or physician organization acting as the licensor to be allowed under Stark Law. However, there are several requirements that must be met for this exception to apply, such as com- pensation must be set in advance, according to the report. Changes to technical requirements 4. Various Stark Law exceptions require the arrangement to be in writing, and in its proposed rule, CMS calls for the relaxation of that requirement. CMS states there is no requirement for a particular kind of writing, and says in certain circum- stances a "collection of documents" may suffice. However, CMS did not provide specific examples of when a collection of documents could satisfy the writing requirements, according to the Mondaq report. 5. Current Stark Law exceptions for equipment rentals, space rentals and personal services require the arrangements to have a term of at least one year. In the proposed rule, CMS explains that the one-year term requirement can be satisfied as long as contemporaneous documentation can be produced that shows the ar- rangement lasted for at least one year. 6. Multiple Stark Law exceptions re- quire an arrangement to be signed by all parties. Under the proposed rule, parties would be given 90 days to ob- tain any missing signatures regardless of whether the failure to originally get the signatures was inadvertent or not. Currently, when the parties' failure to obtain a signature is not in- advertent they are required to get the signatures within 30 days, according to the report. n O utpatient spine surgery is becoming much more viable now than even five years ago. I have transitioned my practice to doing all of my non-Medicare cervical spine surgeries and more than 50 percent of my non-Medicare lumbar surgeries as outpatients. This includes the larger fusions in the cervical and lumbar spines that used to stay in the hospital two to three days. Better techniques in surgical approaches and anesthesia have made this transition possible. I think the trend will continue in the private practice world. In the employed physician model, there is much less incentive for moving to outpatient sur- gery and ownership in ASCs are more rigorously discouraged if the surgeons take their cases from the balance sheets of their employers. n Outpatient Spine Surgery: Which Cases Are Coming in the Future By Jeffrey Carlson, MD

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