The Office of the Inspector General posted an Advisory Opinion on a multispecialty physician group's arrangement with a hospital to find cost-savings in neurosurgical services related to spinal fusions.
The partnership is a gainsharing model, which has been under scrutiny in the past, but the OIG gave the model a favorable opinion. The three-year contract agreed to share the cost-savings with neurosurgeons who worked together to select implants and material for standardization and use preferred products when medically appropriate. The partnership developed 34 cost-saving opportunities, including reducing the use of bone morphogenetic protein, which was performed in around 29 percent of spinal fusions at the medical center and the neurosurgeons did not receive shared savings from reducing BMP beyond the 4 percent floor.
To standardize the processes, neurosurgeons determined safe and effective products and then assess which were most appropriate based on clinical criteria. Then the neurosurgeons used preferred products, even when it changed their clinical practices. The patients were notified about the program.
The OIG said the program had a low risk for fraud and abuse — according to JDSupra, here are five reasons why:
- Distributions were paid on a per capita basis to neurosurgeons
- Potential savings were capped based on spinal fusion volume
- Aggregate group payment didn't exceed 50 percent of projected cost savings
- There was a program oversight committee that reviewed data
- The group retained a percentage of savings exclusively for administrative and recruitment costs
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