Gainsharing article published in Massachusetts Medical Law Report

My article entitled Gainsharing: providing care in a more economical way was just published in the Spring issue of The Massachusetts Medical Law Report, a quarterly put out by the folks at the Mass. Lawyers Weekly.

Among other things, it touches on the relevant regulatory framework and programs under which gainsharing demonstration projects may be implemented. 

Working together with a colleague at The Bard Group, I prepared an application on behalf of a client earlier this year for the MMA Section 646 gainsharing demonstration project described in the article; CMS has not acted on any of these applications yet. 

It is interesting to see how CMS continues to use demonstration projects in general.  CMS says:

Our demonstrations study the likely impact of new methods of service delivery, coverage of new types of service, and new payment approaches on beneficiaries, providers, health plans, states, and the Medicare Trust Funds.

See my earlier HealthBlawg posts on gainsharing and P4P demonstration projects here.

I look forward to the approval and evaluation of the gainsharing demonstration projects, and the eventual adoption of clear guidance bringing legitimate gainsharing programs inside CMS’s big tent.  It seems to me that it is a worthwhile approach that should be available to a broader range of providers.  Meanwhile, the OIG advisory opinion process (and potentially the rejuvenated CMS Stark advisory opinion process) is the mechanism available to providers seeking to implement gainsharing programs.

— David Harlow