A new report indicating that physician-hospital gainsharing programs could save millions of dollars without compromising care may not be enough to push the government into implementing such projects.
The report, published in the May-June issue of the journal Health Affairs, found that savings from gainsharing programs cut costs associated with coronary stents by 7.4%, or $315 per patient, which, if extrapolated nationwide, would equal $195 million in savings annually. In addition, there was no evidence of decreases in quality or access, according to Jonathan Ketcham, lead author of the report and an assistant professor at the School of Health Management and Policy at Arizona State University, Tempe.
But congressionally authorized gainsharing demonstration projects languish in CMS limbo, apparently from a lack of funding. Weve been waiting for forever for these to arrive, says healthcare consultant James Reynolds, president of New York-based Reynolds & Co.
In 2003, the Medicare Modernization Act authorized demonstrations at up to 72 hospitals, and Reynolds says the Deficit Reduction Act of 2005 appropriated $6 million to be split evenly between six demonstration projects. But when the CMS released requests for proposals for the demos, the money had been pulled.
There was no funding whatsoever, Reynolds says. Hospitals and systems would have to do it on their own hook.
CMS spokesman Donald McLeod could not confirm whether the funding had been pulled but says that the demos are still in the works.
We havent dropped them, McLeod says. Were still moving on them, but some things move faster than others.
Ketcham speculates that the projects might be stalled because they lost their congressional champion when Rep. Nancy Johnson (R-Conn.) was defeated.
But an aide for Senate Finance Chairman Max Baucus (D-Mont.) says that Congress still supports the projects. The gainsharing demonstration programs appear to have stalled at CMS, said the aide in an e-mail, who agreed to be quoted on the condition he not be identified. Sen. Baucus is supportive of these demonstrations moving forward. He believes that gainsharing is a concept that may have merit but that should be examined before applying it to broader swaths of the Medicare program.
Another reason for the scarcity of gainsharing agreements, experts say, is the fear of running afoul of the civil monetary penalties provision of the Social Security Act. Federal officials have also been wary that such agreements would result in stinting, meaning that costly but justified quality improvement measures are avoided; cherry-picking, where only healthy patients are chosen; or steering, in which sicker patients are admitted to hospitals where gainsharing isnt practiced.
The CMS is promoting gainsharing in other ways. The agency last month announced a new demo for hospitals to test bundled payments for hospital and physician services for selected episodes of care through Medicare fee-for-service plans, including gain-sharing. The demonstration provides an opportunity for selected providers to develop efficiencies in the care they provide to beneficiaries through increasing market share ... improved coordination of care among specialists and gainsharing, according to a CMS news release.
In the Health Affairs report, Ketcham and colleagues examined the records of 220,520 coronary catheterization laboratory patients from October 2001 through December 2006, comparing the data from the only six catheterization laboratories with gainsharing programs to 123 laboratories without it. Experts say they believe similar savings could be seen in orthopedics and other healthcare sectors.What do you think? Write us with your comments at [email protected]. Please include your name, title and hometown.