Biomedical subjects
Publications and source records attributed to Max Reynolds.
The federal government has long been concerned about several types of discount arrangements, some of which are increasing in sophistication, including: Swapping. Bundling. Tiered discounts. Free use of high-end equipment in return for protocols or data.
Hospitals may participate in gainsharing arrangements, but those arrangements should include safeguards that will minimize regulatory exposure. Gainsharing provides a powerful means by which hospitals and physicians can reconcile their conflicting economic interest while promoting quality of care. Hospitals are challenged to structure gainsharing arrangements so they maximize productive hospital-physician collaboration while minimizing the OIG's compliance concerns.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
As phase II of the Stark law becomes a reality, hospitals will find that the new physician self-referral regulations fall into three categories: the helpful, the unhelpful, and the marginal. Providers need to understand the principal changes in each category and modify their compliance efforts when compensating physicians.
The HHS Office of Inspector General (OIG) seemingly has reversed its formerly unwavering prohibition on gainsharing arrangements. In Advisory Opinion 01-1, the OIG approved an arrangement between a hospital and a physician group targeted at reducing operating expenses as long as they adopted appropriate safeguards to protect against Federal healthcare-program fraud and abuse. With similar approval, hospitals could take advantage of this opportunity to enter into their own gainsharing arrangements with physicians. There are, however, limitations that should be considered when structuring any preliminary gainsharing initiatives. Several Federal laws already exist that define and restrict gainsharing arrangements.