Per-click, under arrangement, mark-up, and other dirty words.

So, the winners under these CMS proposals are OBs in rural areas and people who make minor mistakes when trying to meet a Stark exception. The losers are diagnostic test purchasers, per-click lease participants (at least when the lessor is a physician), and hospitals and physicians who are involved in UA arrangements. Those left in limbo (since they were not addressed) are block lease participants as well as per-click lease parties where the physician is both the lessee and the source of patients. Of course, this is not the last word. CMS will take public comments on the proposals until August 31, 2007. We will then have to wait in suspense for the final rule, which could take years (although it is possible that at least some of the current proposals could be finalized soon since they are currently part of the 2008 Physician Fee Schedule proposal.) This suspense is only heightened by the impending Stark II Phase III rules. For the full text of the CMS proposals, go to www.cms.hhs.gov/physicianfeesched/downloads/CMS-1385-P.pdf?agree=yes&next= Accept.