Published by Compliance Today
Through the development of Accountable Care Organizations (ACOs) and other third-party payer programs, cost savings arrangements between hospitals and physicians are becoming an increasingly important tool for the efficient operation of hospital service lines and outpatient clinics. Historically, similarly structured agreements, such as gainsharing arrangements, have been scrutinized by the Office of the Inspector General (OIG) for a multitude of reasons. However, there have been numerous favorable OIG Advisory Opinions related to these arrangements. From these opinions, one can identify guidelines for a compliant shared savings agreement. This article will address five pertinent guidelines related to shared savings arrangements that a hospital should consider.
1. Patient safety parameters
Certain safeguards should be in place to protect the patient population. Legal counsel typically includes these parameters to ensure the quality of care will not be negatively affected by the program. A few key points from the favorable OIG opinions related to this initiative are:
- The arrangement should be administered by a program administrator whose compensation is not related in any way to the cost savings agreement or physicians’ compensation.
- The program should contain significant safeguards to protect against inappropriate reductions or limitations in services.
- The program should have an independent reviewer or auditor review the program prior to commencement and at least once per year.
- Patients treated under the arrangement should have their care monitored by a quality or safety committee.
- Written disclosure of the program should be provided to patients prior to admission or prior to the approval of the relevant procedure.
