Tuesday, May 13, 2008

Physician Gain-Sharing: What a Tangled Web We Weave

In an effort to control costs, it seems the Department of Health and Human Services is exploring physician gain-sharing programs:
The Health and Human Services Office of Inspector General has approved a handful of gainsharing arrangements in which physicians receive cash payments for reducing hospital spending. Gainsharing might reduce costs by aligning hospital and physician incentives, but concerns remain about quality and access.
But there are significant concerns with this approach:
Although the approved programs incorporated safeguards, questions remain regarding whether such narrowly structured programs can effectively reduce costs without harming access and quality. Specific concerns focus on whether physicians respond to gainsharing by limiting their use of quality-improving but costly devices ("stinting") or by treating only healthier patients ("cherry-picking") and avoiding sicker patients ("steering") at their gainsharing hospitals. Because of concerns about cherry-picking and steering, the OIG prohibits payouts to physicians with changes in their patient mix, measured by the prevalence of high-cost, high-risk patients. The OIG also has expressed concern that physicians would increase their caseloads within gainsharing programs, essentially receiving payments for referrals. To limit this, the OIG has required that any savings generated by an increased volume of patients insured by Medicare or Medicaid could not be included in physicians’ payouts. Others have expressed concern that gainsharing might limit patients’ access to new, beneficial drugs and devices.
Note that the "savings" are passed on to the hospital and doctor, but not the patient (nor their insurer).

Are we potentially robbing the poor to pay the rich with this approach?



Anonymous said...

Given the hefty compensation netted by the top staff at (most) not-for-profit hospitals, you may have, once again, hit the nail on the head, Dr. Wes.

If you haven't looked (of course you have, but just in case):

http colon slash slash wherethemoneygoes.com

I don't want to here, oh beloved readers, that these CEOs NEED that money because of all the donations they bring in, that is a crock.

Oil companies, the big ugly bad boys of the media, should have it so good!

Rogue Medic said...

Potentially? :-)

I love it when the government decides to do something that might "appear" unethical, but uses all of the government's ethic authority to make rules to guarantee that there will be nothing improper coming out of it.

The Happy Hospitalist said...

Um, this program already exists. It's called hospitalist medicine

DrWes said...

Wow, thanks for bitch-slapping me back to reality, Happy. What was I thinking? Of COURSE doctors now have to collude with hospitals to maintain their salaries - especially in light of the continued Medicare cuts and arcane coding practices inherent to our system. I'm so glad it's all being sold as a "cost-cutting" measure by the Office of the Inspector General. Wouldn't want anyone to know...

Anonymous said...

what's old is new. the enemy of my enemy is my friend. maybe the tide is turning and physicians will be viewed as professionals again, rather than presumed criminals by cms and hhs.

well, no bitterness here