Among the first questions that hospitals usually ask themselves when considering developing a co-management agreement with physicians is: “What can we pay?” An appropriate answer is: “What are you paying for?” On the basis of a number of guarantees under the agreement, including the development of bonus criteria by a committee that also includes suppliers outside the cardiology group, and that the group`s performance and remuneration should be verified by an independent consultant, the OIG stated that it would not impose sanctions on the applicant parties. We found that the development of the co-management contract can be accelerated in the event of the intervention of independent consultants. While the use of the hospital board can spare the parties, it can cause conflicts, because the lawyer not only develops the agreement, but they also represent the hospital. The involvement of independent advisers resolves this conflict. As a general rule, co-management agreements have compensation structures that contain fixed elements and incentives. But beyond these common characteristics, the question of millions is: “What services are provided under the agreement?” As part of the antikickback analysis, the OIG found that “safe harbor” contracts for personal services and management contracts (42 CFR 1001.953 (d)) were potentially applicable but could not be honoured, as overall payments had not been predeterded under the agreement. The OIG then considered several reasons for not imposing sanctions. First, the OIG found that compensation was fair value and that important services were provided as part of the administrative agreement. Second, the OIG found that the remuneration was not consistent with the number of patients treated, so that an increase in transfers does not result in additional compensation.
Third, the OIG concluded that compensation was unlikely, that there was an incentive to defer transfers, given that the hospital has only Cath laboratories for 50 miles and the group performs such procedures only in the hospital laboratories. Fourth, the OIG found that the specificity of the measures contributed to their objective being to improve quality and not reward referrals. Finally, the OIG found that there was a written agreement lasting three years. For cardiologists, co-management requires them to be present and responsible to lead the Cath lab and achieve quality goals. This means: more time in the hospital, more time with hospital management staff, more time to work on doctor-physician relationships, more time for quality improvement activities and more time to exchange and compare patient outcomes. Since an agreement on the co-management of Cath Lab involves the payment of compensation to physicians who refer patients to the hospital or health care system, the agreement must be properly structured to avoid violations of public health law and/or regulation. As part of the CMP analysis, the OIG concluded that the only aspect of compensation under the co-management agreement that included the MPC was the cost-saving component. The OIG noted that standardization provisions may encourage physicians to change their current medical practices to reduce or reduce benefits.
However, the OIG has found sufficient safeguards not to impose sanctions. First, the OIG found that the hospital had certified that the regulations would not affect patient care.