MDNews - Cleveland-Akron-Canton

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The parties to the proposed arrange- ment included a non-profit hospita l, a wholly-owned subsidiary of the hospital that provides ma nageria l ser vices, a multi-specialty physician group includ- ing four neurosurgeons on the hospital's active medical sta‚ who perform spinal fusions, and a third-party administrator. The hospita l, through its subsidiary, would pay the neurosurgeons partici- pating in the a rra ngement a sha re of three years' cost savings for selecting standardized products and implement- ing other evidence-based, cost-sharing measures, without compromising qual- it y or deny ing ser vices to Medica re/ Medicaid beneficiaries. The a rra ngement 's administrator, who collected data on a nationa l sca le, identified 34 cost-savings opportunities that included using bone morphogenetic protein on a n "a s needed" ba sis, a nd enc ou r a g i n g neu ros u r ge on s t o u se cost-e‚ective standardized devices and supplies for performing spina l fusions. T he a r r a n gement wou ld i nc lude sa feg ua rds, such a s monitor ing a nd documentation requirements to assure qua lity of ca re a nd to protect aga inst inappropriate reductions of services. The parties promised to appoint an oversight committee to monitor the arrangement's operation and to minimize the risk of "cherry-picking " or steering away more costly patients. For example, the doc- tors would be prohibited from selecting patients to participate in, or withdraw- ing patients from, the arrangement. To promote transparency, the hospital, subsidiary and physician group would maintain documentation certifying the nature and cost of ser vices furnished under the a rra ngement. Patients a lso would receive notice of the arrangement, a long w ith a n oppor tunit y to rev iew details regarding cost-saving measures and the compensation arrangement with the physicians. At the end of each year in the three- year arrangement, cost savings would be ca lculated for each recommenda- tion using a mu lti-step process t hat would consider historica l costs of each product covered by the a rra ngement ( ba se yea r cost), divided by the tota l number of un its. The pa r ties wou ld reset the base year annua lly to remove ea rlier-accomplished sav ings. Nex t , the tota l cost for each product used in spinal surgeries covered by the arrange- ment in the performance year would be divided by the tota l number of products used. Third, the performance year cost wou ld be compa red to t he ba se yea r cost for each product to determine the performance year savings. Once the performance year savings are ca lculated, the hospita l would transfer a n a mount equa l to 50 percent of the tota l performance year savings to the subsidiary, which would make separate pay ments to the physicia n g roup for the first, second and third performance years' savings. Following the physician g roup's receiv i ng t he adjusted tot a l per for ma nce yea r sav i n gs f rom t he subsidiar y, payment would be paid on a per capita basis. The OIG analyzed the arrangement under the Gainsharing Civil Monetary Pena lt y st at ut e a nd A nt i-K ickba ck Statute. It determined that the Requestors had implemented su¥cient, reasonable sa feg ua rds to develop cost-sav ings, without sacrificing quality or limiting medically necessary services to Medicare/ Medicaid patients. Therefore, it concluded that the arrangement would not violate the Gainsharing Civil Monetary Penalty statute. The OIG also concluded that the arrangement, as structured, presented a low risk of fraud and abuse under the Anti-Kickback Statute. This latest pronouncement on permis- sible gainsharing is limited only to the Requestors, but the opinion provides valuable guidance for other physician specia lties looking to enter into cost- sharing arrangements with hospitals. J o e F e l t e s i s a n a t t o r n e y w i t h Buckingham, Doolittle & Burroughs in Canton OH and a member of its Health & Medicine Practice Group. He is also the managing partner of Buckingham Canton. For more information about the law firm, go to www.BDBLAW.com or email Mr. Feltes at Jfeltes@BDBLAW.com. ■ Latest Guidance for Physician-Hospital Gainsharing Arrangements OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS OIG POSTS BY JOSEPH J. FELTES, JD 0 5 M D N E W S . C O M /// M D N E W S C L E V E L A N D /A K R O N / C A N T O N ■ J A N U A R Y/ F E B R U A R Y 2 018

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