The OIG issued two new advisory opinions last month (posted this week) blessing a cardiac surgery gainsharing arrangement and a related anesthesiology gainsharing arrangement.  These advisories parallel the gainsharing advisories issued by the OIG to date — discussed in earlier posts and an article I’ve written here and here.

While gainsharing has been gathering a head of steam under the authority of this family of advisories, CMS has two nascent gainsharing demonstration programs, one authorized by MMA 646, the other authorized by DRA 5007.  I’ve been involved in the development of one application under each program that has made it to the preliminary approval stage, and once OMB and who-knows-who-else signs off on the approvals, these things should progress further and be implemented one of these days.

Once CMS has had a chance to digest information on the OIG-approved gainsharing programs, as well as the demonstration projects, I hope that there may be a more general acknowledgment that gainsharing should be permitted without the need for individual advisory opinions.   (I know, I know: there are Stark issues to consider as well, and the little-used Stark advisory process may be a mechanism for vetting these issues — though the gainsharing deals discussed above have not included Stark advisories in the armamentarium.)

David Harlow