HHS gives mixed blessing to gainsharing arrangement

The HHS Inspector General's office has given a new gainsharing agreement a thumbs down, but decided not to slap the provider in question with sanctions. The gainsharing agreement in question involved an academic medical center working with orthopedic surgery and neurosurgery groups with active privileges at the center. The parties involved were sharing the savings incurred by limiting their use of bone morphogenetic protein, a bone growth stimulant. The groups and academic medical center also standardized the use of 35 spine fusion devices and supply products as appropriate. They contacted the HHS IG to get the office's opinion on this set-up.

The HHS IG said that while the arrangement was transparent and based on "credible medical support," it might have induced doctors to cut back on services impermissibly, as the law calls for civil monetary penalties against hospitals that pay doctors to reduce or limit items or services for Medicaid or Medicaid beneficiaries under their care.

But what of the fact that HHS isn't suing the center and groups? HHS has emphasized that despite the fact that it's not seeking monetary penalties, it has dubbed the arrangement "improper" and that it could have provided forbidden reimbursement to doctors. In other words, it definitely doesn't approve of what the parties involved had been doing.

To learn more about this opinion:
- read this Modern Physician piece

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