Gainsharing Arrangements and Bundled Payments: OIG Advisory Opinion and Other Developments

The OIG has issued a number of Advisory Opinions related to gainsharing arrangements. Following the modification of the gainsharing civil money penalties (CMP) by MACRA in 2018, the OIG issued an advisory opinion analyzing a hospital's payment of a percentage of cost savings to neurosurgeons in a multi-specialty physician group. The OIG approved the arrangement but made it clear that gainsharing payments must be structured appropriately and monitored or they will pose risks.

Gainsharing arrangements offer significant opportunities for hospitals and physicians to collaborate in improving quality of care, enhancing efficiency, and reducing costs. Identifying and realizing these opportunities requires significant operational, legal, and consulting expertise. Healthcare counsel face a variety of legal and regulatory hurdles in structuring gainsharing arrangements. These arrangements must be carefully structured to comply with the gainsharing CMP, the Anti-Kickback Statute, and the Stark Self-Referral law. Other legal and business challenges revolve around state laws, provider relationships, insurance markets, and fair market value determinations.

Listen as our authoritative panel examines gainsharing arrangements, the implications of the advisory opinions, and the critical operational and regulatory concerns when structuring and documenting these types of arrangements.

1. OIG's advisory opinions on gainsharing arrangements
2. Clinical and operational issues in structuring gainsharing arrangements
3. Legal hurdles to structuring and documenting these types of arrangements
4. Opportunities available under bundled payment programs
5. FMV considerations of gainsharing and bundled payment arrangements

The panel will review these and other key issues:

• What are the key operational and regulatory concerns for healthcare providers considering gainsharing arrangements either as stand alone programs or as part of bundled payment programs?
• What are implications of the OIG advisory opinions on gainsharing?
• What critical provisions should counsel document when formalizing these arrangements?
• What are different types of gainsharing arrangements and what are key features of each?