The state of gainsharing arrangements

It has been roughly a year since the Office of Inspection General issued Advisory Opinion 01-1 approving a gainsharing arrangement between a hospital and a group of cardiac surgeons. Advisory Opinion 01-1 caught some by surprise, given the position taken by the OIG in its July 1999 Special Advisory Bulletin that gainsharing arrangements were contrary to the provisions of Section 1128A(b)(1) of the Social Security Act. To many, the Special Advisory Bulletin put an end to any plans to establish a gainsharing arrangement. Many questioned whether Advisory Opinion 01-1 would result in a renewed interest in establishing gainsharing arrangements between hospitals and physicians. If the number of OIG advisory opinions issued by the OIG addressing gainsharing arrangements subsequent to Advisory Opinion 01-1 is any indication, the answer to this question is a resounding no. It is possible, however, that some hospitals established gainsharing programs but simply chose not to seek an OIG advisory opinion on the arrangement. Alternatively, some hospitals may have decided not to enter into true gainsharing arrangements with physicians, but instead are exploring hybrids of true gainsharing arrangements more akin to management or consulting arrangements.