The OIG released another advisory opinion this month approving a cardiac surgery gainsharing program. The key elements, as in the previously approved cardiac gainsharing programs (see the early 2005 opinions, 05-01 through 05-06, here), are "open-on-use" policies (thus reducing waste of unused OR supplies which have been opened in advance) and limiting the use of certain drugs to cases in which they are shown through benchmarking studies to be necessary and appropriate.
The OIG maintains that this opinion is consistent with the 1999 special advisory bulletin finding gainsharing arrangmenets genreally to be in violation of the anti-kickback statute. The opinion lists the ways in which the proposed gainsharing program satisfies concerns about potentially improper limitation of services provided to beneficiaries, and potentially improper financial incentives.
Clearly, the OIG is getting more comfortable with gainsharing. As more opinions are issued, and as the two series of gainsharing demonstration projects get under way next year (see earlier posts here and here), this is likely to become a more and more mainstream approach to aligning physician and hospital incentives, and to expand beyond cardiology services as well.
— David Harlow
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