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News You Can Use: Protect Your Facility With Cost-Saving Safeguards

Failure to implement strategies could attract the OIG

 
A failsafe way to reward doctors who save you money

Arrangements that allow hospitals to share savings with physicians who implement money-saving strategies typically draw fire from the HHS Office of Inspector General. But a plan submitted in a Feb. 4 Advisory Opinion (No. 05-01) won tentative approval for both protecting patient care and guarding against referrals.

The plan: Over a one-year period, a hospital paid a cardiac surgeon group 50 percent of the savings achieved by curbing the inappropriate use or waste of specific medical supplies during designated surgery procedures. For example, performing blood cross matching only when a transfusion is required, or substituting less expensive catheters for more commonly used ones.
Some key safeguards that clicked with the OIG:

1. The hospital clearly and separately identified specific cost-saving actions. The hospital also allowed for public scrutiny, including written disclosures to patients.

2. The arrangement capped savings gleaned from procedures on Medicare beneficiaries.

3. A committee periodically assessed the plan's impact on the hospital's clinical care. If reductions in services exceeded an established baseline threshold, the doctors received no payment.

4. Individual surgeons were not rewarded for generating extra savings. However, they were held accountable for any adverse effects on patient care.
To read the opinion, go to .

According to the AHA, physician-owned facilities put you - and your patients - at risk

Congress' moratorium on the referral of Medicare patients to new physician-owned specialty hospitals is set to expire in June. But the American Hospital Association (AHA) says new evidence supports a permanent freeze on the facilities.

In a Feb. 16 study conducted in four cities over a five-year period, the AHA says it found "rapid and dramatic shifts in referral patterns of physician-owners" that seriously jeopardized full-service hospitals. Here are two key findings AHA will most likely bring to Capitol Hill:
Increased costs = big cutbacks: Physician-owners drained resources by redirecting less costly patients to their own facilities, according to the study.

The result: An onslaught of cutbacks in areas such as behavioral healthcare, services for low-income patients, and health education and awareness programs. Full-service hospitals also lost revenue they needed in order to upgrade technology.

Inhibited patient access to emergency and trauma services: When physician-owners moved their practices to facilities without emergency departments, specialists often reduced or eliminated their on-call emergency coverage, the study said. This caused a chain reaction that brought Oklahoma's only Level I trauma center "to the brink of closure," the report reads.

To read the report, go to .

Heads-up for memo on Part A-Part B union

CMS issued [...]

- Published on 2005-03-22