The CMS decided not to finalize a proposed exception for gain-sharing and incentive payment arrangements under the Stark restrictions on physician self-referral, concluding in a final rule issued Oct. 30 that the agency needed more input in order to get it right.
In the 2009 physician fee schedule that came out in June, the CMS floated the idea of creating specific criteria for the two categories of arrangements, both of which promise to improve quality and efficiency yet also pose risks of creating problematic financial relationships between hospitals and physicians who refer patients to them for Medicare services.
The agency received 55 comments and a majority of them supported the idea—but only if “substantial modifications” were made. Some requested that there be two separate exceptions. One would be for gain-sharing, or what the CMS calls “shared savings programs,” in which hospitals share the financial benefit with physician groups that adopt cost-savings measures for expensive procedures such as heart surgery. The other would be for hospital-sponsored incentive programs, such as pay-for-performance.
The comment period will be reopened for 90 days “to acquire information that will better inform the development of an exception that is sufficiently flexible to encourage the development and implementation of beneficial, nonabusive incentive payment and shared savings programs that foster high-quality, cost-effective care for our beneficiaries.” (See the
final rule, specifically pages 385-414.) --
by Gregg Blesch
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