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CMS-1403-FC
reflect objective quality outcomes or standards but instead
may be vehicles to reward referrals.
We proposed in the CY 2009 PFS proposed rule that an
incentive payment or shared savings program must be
reviewed prior to implementation of the program and at
least annually thereafter to ascertain the program’s impact
on the quality of patient care services provided by the
hospital. We proposed that this review must be performed
by an independent medical reviewer; that is, the review
must be conducted by a person or organization with relevant
clinical expertise that is not affiliated with the hospital
operating the program under review and not affiliated with
any physician participating in the program or with any
physician organization with which a participating physician
is affiliated. We also proposed that the reviewer could
not be participating (at the time of the review) in any
incentive payment or shared savings program operated by the
hospital (73 FR 38553 through 38554). A substantial number
of commenters objected to the requirement of independent
medical review, claiming that the expense of independent
medical review would likely be significant, and that many
hospitals may not be able to find an “independent” medical
reviewer. Commenters also contended that the impact on
patient care can best be ascertained through individuals
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