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

Complying With Legal and Regulatory Requirements, Overcoming Implementation and Operational Challenges

A live 90-minute CLE webinar with interactive Q&A


Thursday, November 14, 2019

1:00pm-2:30pm EST, 10:00am-11:30am PST

Early Registration Discount Deadline, Friday, October 18, 2019

or call 1-800-926-7926

This CLE webinar will provide healthcare counsel with a review of current issues related to gainsharing arrangements whether they are freestanding or part of bundled payment programs. The panel will discuss the OIG's advisory opinions on gainsharing arrangements, outline implementation and operational aspects of gainsharing, and offer best practices for hospitals and physicians to identify business opportunities and minimize legal risks.

Description

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.

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Outline

  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

Benefits

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?

Faculty

Bernstein, Curtis
Curtis H. Bernstein, CPA/ABV, ASA, CVA, MBA

Principal
Pinnacle Healthcare Consulting

Mr. Bernstein specializes in providing valuation, transaction advisory, strategic and operational consulting services...  |  Read More

Mathias, William
William T. Mathias

Shareholder
Baker Donelson Bearman Caldwell & Berkowitz

Mr. Mathias represents clients across the U.S. in all areas of the health care industry, with a particular emphasis on...  |  Read More

Senn, Girard
Girard F. Senn, RN, MS, NEA-BC

Director
Pinnacle Healthcare Consulting

With more than 30 years of senior management and consulting experience, Mr. Senn adds significant depth and breadth to...  |  Read More

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