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Tip: Evaluating gainsharing agreements

Patient Financial Services Weekly Advisor, August 26, 2005

Gainsharing is an arrangement that rewards physicians who achieve cost-saving measures. Although the OIG has approved gainsharing arrangements in several advisory opinions, it's wise to exercise caution before entering into any gainsharing agreement.

Any organization considering a gainsharing arrangement should hire a program administrator to keep track of the accounting and administration of the agreements, advises Anne M. Haule, a partner in the healthcare practice of Ungaretti & Harris, LLP, in Chicago. Because agreements typically last a year, hiring an independent consultant to be the administrator may be a good choice.

Haule says imposing a one-year time frame makes sense because this helps ensure the payment is for legitimate gains. "After that, you could perhaps have a different agreement for a different practice change," she says.

Further, for any gainsharing arrangement, cost savings should be spread across care for all patients-not just for Medicare or Medicaid patients.

Before considering a gainsharing agreement, also consider the potential risk involved-to patients and to hospital-physician relationships. "There's also a political risk," Haule says. "Will it help the hospital and the physicians come together or create more hassle?"

Note: Join HCPro LIVE for the audioconference "Gainsharing: Strategies to structure cost saving arrangements" on Thursday, September 15 at 1:00 p.m. EST.

Attend this 90-minute live audioconference and learn how to enter into appropriate gainsharing arrangements and avoid circumstances that might impact patient care, affect compliance, or violate the anti-kickback or physician self-referral (Stark) statutes.

For more information or to register, contact our Customer Service Department at 800/650-6787 and mention source code EZ38520A, or sign up online by clicking here.

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