Stark II rules define fair market reviews

April 25, 2012

Stark II rules play an important part in determining relationships between physicians and hospitals. See what you need to know about them.

Q: I hear the local hospital reference fair market value in respect to physician compensation. What does fair market value mean?

A: The concept of Fair Market Reviews and Commercial Reasonableness comes from the section of the Social Security Act known as Stark II rules. The preamble to the Stark II rule states: an arrangement will be considered "commercially reasonable" in the absence of referrals if the arrangement would make commercial sense if entered into by a reasonable entity of similar type and size and a reasonable physician (or family member or group practice) of similar scope and specialty, even if there were no potential designated health service referrals.

This means the arrangement between physicians and hospitals must not have anything to do with referrals that hospitals can generate from the relationship. The measure of these arrangements is the commercial reasonableness or fair market value. The physician and hospital must be able to feel comfortable that any other health system would enter into the same relationship, presuming that there is no referral opportunity.

In essence, hospitals are under constraints through a variety of rules, regulations, and compliance issues to not overpay for reasons other than market value of services. The rules are designed to protect the community and patients from a hospital paying higher than market rates to obtain physician referrals or procedures. Fair market value typically is determined by a third party or a hospital's compliance department. Available physician compensation survey data are used for a physician specialty. Examples of survey data include those from the Medical Group Management Association and Sullivan Cotter & Associates, Inc.

Answers to readers' questions were provided by Thomas J. Ferkovic, RPh, MS, managing director, and Daniel E. Clark, MBA, senior consultant, SS&G Healthcare Services LLC in Akron, Ohio. Send your practice management questions to medec@advanstar.com Also engage at http://www.twitter.com/MedEconomics and http://www.facebook.com/MedicalEconomics.

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