When it comes to finding ways to involve physicians in the oversight of today's medical enterprise, many organizations talk the talk, but few walk the walk.
So it's distressing when institutions that undertake efforts to improve the
status quo are slapped down. The federal government's recent ruling on gainsharing led to just such a result; it's a decision that seems to have thrown the proverbial baby out with the bath water.
Gainsharing plans are partnerships that give physicians control of restructuring the delivery of care in some typically high-cost and inefficiently run areas of hospitals, such as those in which orthopedic implants and cardiac procedures are performed. Under most gainsharing arrangements, doctors receive a percentage of any reduction in hospital costs that they effect as compensation for their time and expertise.
The snag that resulted in the new ruling is a federal law prohibiting hospitals from knowingly making payments directly or indirectly to physicians as an inducement to reduce services to Medicare or Medicaid beneficiaries.
Of course no one would question that vigilance is needed in protecting people who receive care through programs funded by the federal treasury, but do the feds really mean to say doctors shouldn't have a role in reducing unnecessary hospital costs and improving care? That's doubtful, given the alternative is to leave those decisions to bureaucrats and bean counters.
Most physician-hospital partnerships include both quality and antifraud safeguards. For example, a coalition of St. Paul, Minn., specialists is crafting a co-management agreement that would protect against inducements to refer and also assure no payments are tied to volume of services. At Grant Hospital in Columbus, Ohio, quality indicators are routinely measured and reported to doctors as part of a gainsharing program.
Such efforts clearly are needed to end the patient-unfriendly, disjointed, high-cost and low-quality medical care that has been all too common in the past.
But it seems the establishment of best practices and standardized care delivery would be a better way to reduce costs and assure quality than doing away with gainsharing.
It's not clear why HHS didn't choose to evaluate each gainsharing arrangement individually, requiring strict adherence to specific guidelines and establishing sanctions for failure to meet them. However, the agency did leave open the option of paying physicians a fixed fee based on fair market value for services rendered, in lieu of a percentage of costs saved, and we hope physicians maintain an open attitude toward this alternative.
Meanwhile, medical leaders can keep the hope of hospital-physician partnerships alive by working for legislative relief that assures quality care for patients without the unwanted side effect of stifling industry innovation.