In this letter to the Centers for Medicare & Medicaid Services, MGMA President and CEO William F. Jessee, MD, comments on the proposed changes to the Stark physician self referral and hospital acquired conditions regulations noticed as part of the proposed IPPS rule for FY 2009. In the letter, Jessee suggests that it is time for "all concerned to step back and re-examine some structural aspects of the rules that add complexity for group practices." Jessee further notes that as the Stark regulations have evolved over time, "they have become ever more complex to the point where they are now virtually incomprehensible to the average physician or group practice administrator."