With the release of two new advisory opinions by HHS, it's clearer now how hospitals can share cost savings with doctors without running afoul of regulators. One of the two opinions address address anesthesiologists, and the other a group of cardiac surgeons. In both cases, HHS approved arrangements that rely on clinical and historical data for norms to meet, to make sure physicians aren't shaving costs in a way that could undercut care or get rewards that more or less add up to kickbacks.
For example, in the opinion dealing with the anesthesiologists, the HHS opinion permits the anesthesiologists to use a less-expensive catheter when clinical appropriate during surgeries. Since data suggests that it would be clinically appropriate 90 percent of the time, the HHS plan forbids them from profiting for using them more often than that. HHS has placed a similar importance on historical and clinical data when it accepted prior plans, only 10 of which have been approved since 2001.
That being said, it's still important for hospitals and physicians to get explicit approval for their gain-sharing plans, experts say. If parties go ahead with an arrangement that HHS doesn't like, they're still facing legal problems even if a hospital withholds payments to physicians.
To learn more about this issue:
- read this Modern Physician piece
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