Two gainsharing arrangements between a hospital and physician groups are blessed in new advisory opinions from HHS inspector generals office.
The inspector generals staff concluded that the plans for achieving and divvying cost savings with cardiologists and anesthesiologists arent likely to encourage the kind of thriftiness thats bad for patients or provide cover to kickbacks, reasoning that the rules and safeguards outlined are sufficiently specific, transparent and tied to objective clinical measures.
As applied to the anesthesiologists, for example, the physicians reviewed data and determined a cheaper type of catheter could be used in 90% of cases. As a safeguard, the group wont receive any savings tied to using the cheaper catheters in a number of cases that exceeds that threshold.
The two opinions respond to separate requests for rulings on whether the arrangements would trip either a civil monetary penalty for inducing limitations of services or the anti-kickback statute. The requests appear to come from the same hospital because they closely mirror each other, but the identities are redacted from the published documents, advisory opinions 07-21 and 07-22.
Properly structured, arrangements that share cost savings can serve legitimate business and medical purposes, according to Advisory Opinion 07-22. It later adds, though, Improperly designed or implemented arrangements risk adversely affecting patient care, and could be vehicles to disguise payments for referrals. -- by Gregg Blesch
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