CMS Stark Proposals: "Stand in Shoes" & Gainsharing
CMS has proposed new Stark regulations as part of the hospital in-patient perspective payment system rules for Fiscal Year 2009.
On April 14, 2008, CMS proposed new IPPS rules which contain proposed Stark regulations with respect to alternative solutions for the "stand in the shoes" provisions which were first proposed in the Stark Phase III rules and solicits new comments on a proposed exception for gain sharing.
The proposed rules have been posted on the MedLaw Blog and can also be accessed through the link below.
http://www.cms.hhs.gov/AcuteInpatientPPS/downloads/CMS-1390-P.pdf
We will be posting summaries of the "Stand in the Shoes" and "Gain Sharing" proposals written the next several days.
OIG Approves Gainsharing Program for Ortho and Spine
AUGUST 14, 2008
The OIG has approved the first orthopedic and spine gainsharing project.
No details have been released on the participating hospitals or the particular procedures and technologies that will be covered in the project. Additionally, no financial terms have been publicized, though the Goodroe press release says that most arrangements allow participating physicians to be paid as much as 50% of the savings generated under the program. According to Goodroe, up to $75 million in potential savings has been identified in the existing programs, so these benefits could be significant. A 2006 survey found that most physicians felt that gainsharing was an effective way to align financial incentives for hospitals and physicians, though they were divided on what constitutes gainsharing and whether it should be disclosed to patients.
In her guest blog for HealthpointCapital, Goodroe Healthcare Solutions founder Joane Goodroe commented, "Gainsharing is first about assuring quality of care for patients and secondly about increasing efficiency." Industry groups such as MDMA and AdvaMed have taken issue with these objectives, suggesting that gainsharing may reduce the quality of patient care, slow development of new technology and discriminate against smaller manufacturers.
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I've present Gainsharing to MGMA Annual, BONES, MGMA FMS and MSO Societies.
The docs have to approach the hospital - the hospital is not going to be very aggressive about sharing their savings.
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Marshall Maglothin MHA MBA
President, Blue Oak Consulting, LLC
COO, Inpatient Specialists, P.A.
Fairfax, VA / Rockville, MD
mmaglothin@cox.net