Safeguards Built in to Address Legal and Regulatory Matters.
After over a decade of development, the AMS Gainsharing Program and AMS PBIS® are used in both Medicare demonstration projects and in commercial initiatives.
The AMS Gainsharing Program is designed to ensure quality of care is maintained or improved while a participating hospital realizes operational efficiencies. Built-in safeguards protect the patient as well as address legal and regulatory concerns. These safeguards include:
- Medicare Programs. Medicare programs such as BPCI Model 1 / Gainsharing Program provide a waiver from federal laws including Stark, Civil Monetary Penalties and Anti-Kickback. The AMS Gainsharing Program and its AMS PBIS® offer nine specific features (at right) that provide protections and support the waivers granted.
- Commercial Gainsharing Programs. All of the protections for Medicare programs are maintained and incorporated into Commercial Gainsharing Programs. In addition, all commercial programs incorporate a Fair Market Value Analysis to set a separate upper limit on incentive payments. No commercial program is implemented without a legal opinion from local counsel. AMS does not provide any legal advice, but works with its association partners in obtaining a legal opinion to make sure the AMS Gainsharing Program being offered is consistent with each state’s regulatory and legal requirements. Once the association has obtained the necessary legal guidance, it is then able to assist interested member hospitals in obtaining independent legal opinions prior to implementation of the program.
Gainsharing Program Approved by the US Department of Justice.
Hospitals in New York have implemented a commercial gainsharing program powered by AMS PBIS® under the auspices of the Greater New York Hospital Association (GNYHA). As part of the implementation process, GNYHA had sought assurances from the US Department of Justice (DOJ) that its role in administering the commercial gainsharing program would not be considered anticompetitive. On January 16, 2013 DOJ provided a Business Review Letter to GNYHA including description of the role of AMS serving as the independent scorekeeper.