Gainsharing and Congress
BY JOANE GOODROE, OCTOBER 24, 2005
By Joane H. Goodroe
President and CEO
Goodroe Healthcare Solutions, LLC
[Editor's note: We welcome consultant Joane H. Goodroe as a guest blogger. See her profile here.]
On Friday, October 7th, the House Ways and Means Subcommittee on Health held a hearing on gainsharing. I was one of the invited panelists and wanted to share some observations.
Chairman Nancy Johnson began the hearing stating that this was the most important topic that the Committee had addressed during her chairmanship. As she continued with her remarks, it was obvious that she saw gainsharing-type arrangements between hospitals and physicians as key to dealing with our rapidly increasing healthcare costs. I was struck by her understanding that our current healthcare system actually discourages physicians from reinventing processes to save money.
Of course, there were those opposed to the concept. One example was Representative Pete Stark. He cited the example of hospitals employing physicians and dictating their use of products and services in order to save money. He said that this was like the Veteran's Administration Hospitals (VA Hospitals) model. I thought it was an odd example of a solution for several reasons. One, it limits products available to patients based on cost decisions and hospitals do not have the clinical expertise to determine which products are best for patient care. Two, the VA Hospitals are not known for clinical excellence processes or for cost efficiency. This is certainly not an alternative to assure patients access to the best technology for their needs.
Other objections and concerns from some Representatives and panelists were due to their misconceptions about gainsharing. An example given was that a physician may decide not to implant a defibrillator in order to make money. If this was possible under gainsharing, I would be the first opposed. The following outlines how a defibrillator example would work within gainsharing.
- A physician must perform a procedure in order to be eligible for gainsharing. Therefore, the patient must receive a defibrillator in order to be paid for any savings.
- In order to save money, the physician must assure that all clinical criteria have been satisfied. An example of how to save money would be utilizing the appropriate device for the appropriate indications. If there is no medical benefit for a dual chamber device, than a single chamber device would be clinically appropriate while saving money.
- There is no money paid to the physicians if there is any measurable decrease in quality.
Gainsharing is first about assuring quality of care for patients and secondly about increasing efficiency. In my testimony, I called physicians the "engineers" that we need to find ways to assure our resources are used efficiently so that all patients will receive the necessary care. It's a second job for the physicians, they are the only ones qualified to determine what is best for the patient.
