What Have You Got to Gain? A Lot!

December 11, 2017

If I can make you a dollar by cutting your costs, can I keep 50 cents?

That, in a nutshell, is what’s described as “gainsharing” in the context of arrangements between medical groups and hospitals. The physicians, as a part of a structured arrangement, are rewarded for making a hospital service more efficient or more effective.

Regular readers of the blog have probably already spotted the compliance sticking points: Is this is kickback? What about Stark? Hmm, is this gainsharing mumbo jumbo just getting paid to reduce patient care, triggering Civil Monetary Penalties?

Well, yes and no.

That’s indeed the minefield that must be navigated on the way to establishing a safe gainsharing deal. But, if the deal is properly structured, you can legally share in the savings and efficiencies and value of patient care improvements that you help bring about.

Gainsharing deals can be structured in a straightforward manner. In other words, in an arrangement centered around, for example, reducing the cost of drugs.

But, importantly in the larger context, they can be used as a tool in structuring a monetary split in a variety of other contexts, such as within an exclusive contract or as a part of a co-management deal.

The gainsharing concept is not physician-specialty specific. It can be used in a multitude of situations, including both hospital-based and office-based physician arrangements.

For example, there are OIG advisory opinions dealing with anesthesiology, cardiology, and orthopedic surgery gainsharing agreements, among others.

If you make the hospital a dollar by cutting its costs, you can keep 50 cents.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

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