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CMS-1403-FC
clinical practice. Within the category of “shared savings”
programs, we include programs that involve the sharing of
cost savings attributable to physicians’ efforts in
controlling the costs of providing patient care, as well as
hybrid programs that involve both the sharing of cost
savings and payment for improvement or maintenance of
patient care quality. For a discussion of incentive
payment and shared savings programs, DHHS initiatives with
respect to such programs, and our proposed exception for
incentive payment and shared savings programs, we refer the
reader to our solicitation of comments in the FY 2009 IPPS
proposed rule regarding the necessity of an exception to
the physician self-referral law for gainsharing programs
(73 FR 23692 through 23695) and the CY 2009 PFS proposed
rule (73 FR 38548 through 38552).
In the CY 2009 PFS proposed rule, we described our
concerns regarding potential program and patient abuse from
the implementation of improperly structured incentive
payment and shared savings programs. Specifically, we
stated:
Although properly structured incentive payment
programs can enhance health care quality and
efficiency, improperly structured programs pose
significant risks of program or patient abuse,
including adversely affecting patient care.
Moreover, such programs could be vehicles to
disguise payments for referrals, including
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