Gainsharing: a call for guidance.
Gainsharing is a device by which hospitals and physicians share in the development, implementation, and proceeds resulting from the mechanisms to make the provision of healthcare more efficient and cost effective. The goal of gainsharing programs is to save hospitals money while maintaining the same or better quality of care--a goal that will ultimately result in both better care and lower expenses for payors and for society as a whole. Nevertheless, the OIG has ruled that gainsharing programs are per se illegal. This Article analyzes the reasons behind the OIG's determination and argues that, contrary to the OIG's conclusion, the advisory opinion process is legally and practically the best way to deal with the issues raised by gainsharing programs.
Wiehl
J G
JG
Sonenschein Nath & Rosenthal, USA.
Murphy
S L
SL
D000368:Aged; D017046:Cost Savings; D005377:Financial Management, Hospital / Q000331:legislation & jurisprudence*; D006297:Health Services Accessibility / Q000191:economics; D006300:Health Services Misuse / Q000191:economics; D018578:Hospital-Physician Relations; D006801:Humans; D008484:Medicaid / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D008505:Medical Staff, Hospital / Q000191:economics* / Q000331:legislation & jurisprudence; D006278:Medicare / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D010816:Physician Incentive Plans / Q000191:economics / Q000331:legislation & jurisprudence*; D018584:Physician Self-Referral / Q000331:legislation & jurisprudence; D010818:Practice Patterns, Physicians' / Q000191:economics; D014481:United States; D014483:United States Dept. of Health and Human Services