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Be ready for possible mandatory hospital-physician relationship reporting.

If your hospital wasn't one of the 500 that the Centers for Medicare & Medicaid Services selected in the fall of 2007 for its investigation into hospital-physician financial relationships, don't think you're in the clear--you may be next. CMS has indicated that this may be the first step toward implementing a regular financial disclosure process that would apply to all Medicare participating hospitals.

The CMS probe stems from a directive in the Deficit Reduction Act calling for an analysis of the impact of physician investment in specialty hospitals. CMS first took a crack at analyzing these relationships by sending voluntary surveys to 500 hospitals. But after receiving only 210 responses, CMS decided to try again with a mandatory report, and the 290 hospitals that didn't respond to the voluntary reporting survey were some of the first targets.

What began as an investigation of physician investment in specialty hospitals expanded into a sweeping reporting requirement and resulted in the Disclosure of Financial Relationships Report, a comprehensive form requiring detailed disclosure of all financial relationships with physicians and their family members.

The new reporting forms are much more comprehensive than the originals and go beyond the initial intent, says Bob Wade, an attorney and partner with Baker & Daniels, LLP, in South Bend, IN. "What they've done is taken that and, in my mind, given it steroids. They're asking for most financial arrangements that targeted hospitals have with all members of its medical staff," he says.

Although it's unclear how aggressively CMS will enforce violations found in the DFRR, the organization stated that the survey will be "used by CMS to analyze each hospital's compliance" with Stark, prompting many to refer to it as the new "Stark audit survey."

Violations found in the report may implicate other regulations, such as the anti-kickback statute, and the information may be shared with other federal agencies and Congressional committees. Although CMS hasn't specified whether they will give hospitals a grace period or immediately administer penalties if violations are found, hospitals would be wise to address any potential red flags before receiving the report, Wade says.

Administrative burden

One of the chief complaints against the DFRR is that providing CMS with the information requires a great deal of time and resources on the hospitals' part. CMS initially estimated that the form would take only six hours to complete--a claim that many hospitals found "amusing," says Tom Crane, an attorney with Mintz, Levin, Cohn, Ferris, Glovsky and Popeo P.C. The actual amount of work required depends on how centralized their financial records are, but even for the most prepared hospitals "the real [time requirement] will be many, many times greater than what CMS indicated," Crane says.

Hospitals must disclose financial documents for physicians and the hospital, including leases, medical director agreements, on-call stipends, and even charitable donations and nonmonetary compensation arrangements, including birthday presents and tickets to sporting events. And that's just one of the eight worksheets; leases, under arrangements and ownership interests must also be included.

A hospital that receives the DFRR has 60 days to submit a completed survey to CMS. Failing to do so can result in penalties of $10,000 per day. A chief executive officer, chief financial officer or comparable officer of the hospital must sign off on the report to verify that the information is accurate.

The best course of action for hospitals that haven't received a letter from CMS is to audit financial relationships and prepare as if they are expecting one, Crane says.

-Elyas Bakhtiari

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