Medicare: Physician Incentive Payments by Hospitals Could Lead to Abuse
HRD-86-103
Published: Jul 22, 1986. Publicly Released: Jul 29, 1986.
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Highlights
In response to a congressional request, GAO analyzed existing and proposed Medicare physician incentive plans to: (1) assess their legality under current law; and (2) determine the potential abuses that could arise under them in view of the changed incentives under prospective payment.
Recommendations
Matter for Congressional Consideration
| Matter | Status | Comments |
|---|---|---|
| In considering legislation to modify the Medicare statute to place additional restrictions on physician incentive plans, the House Ways and Means Committee, Health Subcommittee, may wish to consider prohibiting incentive plans unless hospitals base the decision of whether to pay an incentive on the cost performance of multiple physicians over an extended period of time. In addition, the Subcommittee may wish to consider requiring that such incentive plans: (1) include explicit arrangements for utilization and quality review; and (2) not base the amount of incentive payments solely on each individual physician's cost performance. | Congress prohibited the payment of incentives to physicians for reducing or limiting services to Medicare and Medicaid patients through a provision in the Omnibus Budget Reconciliation Act of 1986. A civil monetary penalty was also authorized for violations of the provision. |
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Topics
BeneficiariesHealth care servicesMedicareQuality of carePhysiciansHospitalsPatient careDiagnosis related groupsKickbacksProfits