Notice: This CMS-approved document has been submitted - Philips ...

CMS-1403-FC
quality resulting from the implementation of the incentive
payment or shared savings program; and [14] requirements
(including timeframes) for the hospital to take corrective
action based on the reviewer’s recommendations.
(2) Participating physicians and payment amounts
The proposed exception included a requirement that the
incentive payment or shared savings program be structured
to require physician participation in the program in pools
of five or more physicians, with payments being distributed
to members of each pool on a per capita basis. Under the
proposed exception, all physicians participating in the
program must be on the medical staff of the sponsoring
hospital at the commencement of the program. Most
commenters objected to these requirements, but did not
provide clear suggestions regarding how to address our
concern regarding disguised payments that reward referrals
or other business generated by the physician in the absence
of such structural requirements. Therefore, we are seeking
specific comments on alternatives to these participation
and payment restrictions, as well as other safeguards that
we could include in an exception(s) if we were to omit the
“five-physician pool,” per capita payment distribution,
and/or medical staff membership requirements. We request
comments as to [15] whether, if pools of less than five
399