Published: 2009-09-17 22:01:48
Author: ASBURY PARK PRESS | August 24, 2009
A three-year study is under way at a dozen New Jersey hospitals — including Monmouth Medical Center, Jersey Shore University Medical Center and CentraState Medical Center — to see if paying doctors to cut costs is an effective way to save hospitals money. More than 500 physicians have agreed to participate.
It's worth a shot. The multi-headed monster of out-of-control health care costs has to be fought with every fiscal tool in the arsenal as long as patient care isn't compromised by bean-counters and people looking to goose the bottom line.
The practice of rewarding physicians with cash for cutting hospital costs has a name — "gainsharing" — and it is generally prohibited by federal law. The fear is that if it became widespread, doctors would begin cherrypicking patients, leaving the sickest and most vulnerable patients behind. But pilot programs such as this one are granted waivers to allow the study of gainsharing's effects on patient care and costs.
This current study, similar to other pilot programs in other states is a Medicare program that is spearheaded locally by the New Jersey Hospital Association. In many cases, doctors and hospitals are at cross-purposes when it comes to billing: The program is intended to address a conflict in the Medicare payment system in which hospitals are paid a lump sum based on each patient's diagnosis while doctors are paid for each service they provide the patient, giving them no incentive to cut costs for the hospital. An extra day's stay for the patient might mean more money for the doctor while it costs the hospital substantially.
Sean Hopkins, a senior vice president of the state hospital association, says half of New Jersey's hospitals are losing money each year. And Medicare, the government's insurance program for senior citizens and the disabled, reimburses hospitals in the state only 89 cents on the dollar. The incentives to doctors for saving the hospital money could be as much as $300 for a surgery patient and $100 for other admitted patients.Full story