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CMS-1403-FC
the alternative, we proposed a surrogate method of capping
total available payments that would be actuarially
equivalent to a 50 percent cap with annual rebasing of
baseline statistics. Many commenters responded that we
should impose no limits on how a hospital determines the
amount available for shared savings payments, while other
commenters objected to the 50 percent cap and/or the
rebasing requirement. As we noted in the CY 2009 PFS
proposed rule and above, our goal is to finalize an
exception (or exceptions) that provide sufficient
flexibility for hospitals to structure and implement a
variety of nonabusive incentive payment and shared savings
programs. We are seeking comments that specifically
address: [29] what safeguards we could include in an
exception if we do not include a cap on the total amount of
cost savings available for distribution to participating
physicians; [30] what safeguards we could include in an
exception to ensure that physicians are not paid for
achieving performance measures they achieved in prior
periods of the program if we do not require rebasing of the
baseline against which reductions in waste or costs are
measures; [31] whether it is appropriate to permit payments
for continued achievement (or maintenance) of performance
measures, waste reduction or cost savings and, if so, what
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