OIG approves hospital plans to share cost savings with doctors

Gainsharing can help improve quality and lower costs, but it still holds legal risks, experts say.

By Amy Lynn Sorrel, AMNews staff. Feb. 18, 2008.

Two hospital agreements to share with physicians some of the cost savings derived from quality-of-care measures are not likely to violate federal fraud and anti-kickback statutes, according to a pair of Jan. 14 advisory opinions by the Dept. of Health and Human Services' Office of Inspector General.

Gainsharing agreements let hospitals pass to doctors some of the savings facilities reap due to, in part, the physicians' efforts to increase quality and efficiency. Experts said the OIG letters not only offer added insight into what the government sees as acceptable collaboration but also may signal a recognition that gainsharing arrangements -- if done right -- can be a viable way to improve quality.

The agreements face ongoing scrutiny, and the recent examples do not represent a one-size-fits-all solution, experts warned.

The OIG opinions do not name the facility or physician group. One arrangement involves a cardiology practice with hospital privileges and the other involves an anesthesiology group with hospital privileges that provides services during cardiac procedures. In both agreements, the hospital proposes to pass on up to 50% of its savings to the doctors for one year. Both specialty groups are the only ones that provide their respective services within the facilities. The cardiac surgeons refer patients to the hospital for both inpatient and outpatient treatment. The programs outlined initiatives that eliminate wasteful practices and encourage physicians to use specific types of supplies during surgeries.