considerations with program collaborators
physician leaders are pivotal to achieving goals associated with adopting best practices, development of co-management programs and implementing the gainsharing
opportunities offered by new reimbursement schemes such as bundled payments.
Financial Fraud Law Report has published the article OIG Releases New Proposals on Anti-kickback Statute Safe Harbors, Exceptions to the CMP Law and the Gainsharing
Prohibition, written by Jorge Lopez, partner and head of Akin Gump s health industry practice; Robert Salcido and Kelly Cleary, partner and counsel, respectively, in the health industry practice; Caitlin McCormick, counsel in the public law and policy practice; and John Siracusa, a health practice associate.
Under the gainsharing
pilot, those payments were aligned to ensure that hospitals and physicians would work together.
78) Further clarifying its reading of the statute with respect to gainsharing
, (79) the OIG stated in 1999 that appropriately structured gainsharing
arrangements were prohibited, without regard to necessity or prudence as informed by current medical practice, even though they may provide financial benefit to the provider without an adverse impact on the quality of care.
Examine results of a New Jersey gainsharing
program and see how the cost savings used to pay the physicians were achieved.
and that's pretty typical, as we looked at the amount of work [involved] in terms of changing the model of care, setting up gainsharing
models, looking at the patient population, setting up quality measurements.
Doctors in Arkansas are about to find out what that's all about as the state's Medicaid program--along with two private insurance companies--kicks off a gainsharing
programs involve hospitals paying physicians a share of the savings that result from collaborative efforts between the hospital and the physician to improve quality and efficiency in care delivery.
Critics say gainsharing
could provide an incentive to skimp on care.
1) Of course the threshold that physicians must meet to be eligible for gainsharing
bonuses can easily be manipulated and adjusted by a hospital-dominated PHO so as to favor the hospital, while simultaneously limiting the number of physicians who qualify for a gainsharing
One way to promote common success is through a gainsharing