HHS inspector generals office has posted two new advisory opinions approving arrangements in which hospitals pay physicians for savings during procedures and pay-for-performance bonuses from a payer.
In one opinion, the agency approves an existing three-year arrangement between a hospital and a cardiology group, representing the first such opinion to grant leeway to a multiyear agreement. The government has been wary of so-called gain-sharing arrangements because they can present a financial incentive for physicians to scrimp on care to the detriment of patients or mask hospital kickbacks to physicians for referrals. A string of favorable opinions, however, have been granted to arrangements that are sufficiently limited and specific and include safeguards against abuse.
In the second new opinion, the agency says it would not pursue sanctions against a hospital that wants to establish a way to reward its medical staff for helping it meet efficiency and quality targets to win bonus compensation from a private insurer. The payment doesnt involve government funds, but the insurer bases the bonus on whether the hospital meets targets for all patients, including those covered by government health programs. While the arrangement presents similar risks as gain-sharing, the agency concludes that the proposed arrangement has adequate safeguards. -- by Gregg Blesch
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