Physician Strategy News: October-November '07
Is Gainsharing in Your Hospital's Future?
As the landscape of healthcare continues to evolve, hospitals and physicians are looking to better align incentives. Alignment could help with management of resources in the face of rising costs and with quality in the face of growing consumer and payor expectations.
Hospital executives have long lamented the fact that physicians do not give their full focus to hospital QI and cost management issues, because there is no financial benefit (and at times financial penalties) to the physicians for such efforts. Gainsharing allows physicians to be rewarded for improvements in quality and efficiency in the hospital, overcoming that long-standing problem.
To date, gainsharing efforts have been slowed because of concerns about the anti-kickback provision in Stark. But CMS has developed a demonstration project that sets those concerns aside, and they are currently studying the methodologies and innovative partnerships hospitals and physicians create while under legal protection of the CMS demonstration.
The most critical requirement for successful gainsharing collaboration between hospitals and physicians will be the availability of accurate clinical information and its associated cost data. The data must track the clinical outcomes, costs associated with providing care, and the utilization of services incurred providing that care. Quality of care is defined not as episode specific, but as the cumulative effect of treatment.
Ultimately, the data are used to correlate practice patterns with outcomes, and to define benchmarks which serve as best demonstrated practices. Once a standard of care is determined, the medical/surgical equipment and services typically required to provide the appropriate patient care are determined and standardized.
Implied in this is joint management of clinical services, with physicians and executives working together to define the resources needed, and best practices required to produce good outcomes. Based on agreed to measures to improve efficiency and quality, physicians may be reimbursed for their efforts to improve care, although the level of those payments may be limited by regulatory bodies.
At this point, gainsharing is an interesting theory. As CMS learns more from its demonstration projects, there will be more tangible information available. However, it is a reasonable supposition that, by working together, physicians and hospitals will improve outcomes and efficiencies. If that is true, an avalanche of gainsharing opportunities may be in our future.
