OIG Allows Two More Gainsharing Programs; CMS Demos Still Pending
This article is reprinted from "The Gray Sheet" – January 21, 2008 Two more hospital/physician gainsharing programs focused on product standardization got the HHS Office of Inspector General's OK Jan. 14. "This now becomes the tenth opinion that we've secured in this area. It shows there is replication to the model," said Joane Goodroe, president of Goodroe Healthcare Solutions, which designed the projects. Gainsharing arrangements, whereby hospitals share with physicians the cost savings that come from quality and efficiency initiatives, are generally illegal, since physicians may be rewarded for reducing health services, or their referral patterns could be influenced. However, OIG has granted exceptions in certain cases, all designed by Goodroe, stating in the accompanying advisory opinions that it will not impose sanctions because the programs include enough patient protections. |
The two new projects, 1one for a group of cardiac surgeons and 2one for cardiac anesthesiologists at undisclosed hospitals, resemble the Goodroe model that OIG has previously approved, most recently in fall 2006.
As in other projects, Norcross, Ga.-based Goodroe Healthcare Solutions worked with the physicians to develop recommendations for reducing use and waste of medical supplies during certain procedures. The programs were scheduled to last one year.
The cardiac surgeons adopted 25 recommendations: eight involved using certain medical supplies only as needed; 11 included substitutes for products such as skin staplers, wrist splints and blankets; five were standardizations of specific cardiac devices and supplies; and one involved not opening disposable components of cell saver units until needed.
The anesthesiology group eliminated routine use of a specific drug and device for monitoring patient brain function; called for use of a specific catheter and a nasogastric tube made with a less expensive material; and standardized the use of certain fluid- warming hot lines where appropriate.
OIG says there were a number of safeguards in place to ensure that patients receive quality care, including allowing physicians access to a full range of products should they be right for a specific patient, regardless of the recommendations.
Joane Goodroe told "The Gray Sheet" that hospitals using her models have saved on average about 10% of their supply costs in the targeted specialties.
The device industry, however, is upset by the model's reliance on product standardization, which it says may limit physician choice and block competitive products from the market.
CMS Demos Promise New Gainsharing Models
Industry stakeholders including AdvaMed and the Medical Device Manufacturers Association see more promise in two CMS demonstration programs that will evaluate other gainsharing models.
One demo, mandated in 2003 by Sec. 646 of the Medicare Modernization Act, will test gainsharing at up to 72 hospitals for three years (3"The Gray Sheet" Sept. 11, 2006, p. 10). A second, three-year demo was mandated in Sec. 5007 of the 2005 Deficit Reduction Act. It will take place at six sites.
In both cases, CMS has solicited "innovative" gainsharing projects different from the limited, short-term models that OIG has OK'd thus far (4"The Gray Sheet" Sept. 25, 2006, p. 12).
Goodroe says she has worked with hospitals on submitting bids for the CMS demos as well. "We're looking forward to those projects getting started because I think they will uncover new, additional areas" in which gainsharing can help control costs, she said.
The opportunities she is exploring go beyond the procedure-based models she has worked on before to include other ways of streamlining patient care, such as preventing duplicate lab and imaging tests, and keeping doctors from requesting unnecessary consultations.
Though the demos were supposed to begin in 2007, sites have not yet been announced for either of them. CMS says both projects are in the final approval process. The DRA demo is expected to kick off first.
- Chloe Taft
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