Implementation and Monitoring, Support of the Medicare Hospital Gainsharing Demonstration

This demonstration will provide a test of gainsharing in the Medicare program. It will determine if gainsharing can align the incentives between hospitals and physicians in order to improve the quality and efficiency of care. The goal is to improve hospital quality, while focusing on operational and financial performance. The contractor will provide overall implementation and monitoring support for the three year demonstration. All data collected and analyzed for real-time monitoring will subsequently be used for the evaluation; therefore the contractor will collaborate with the evaluation contractor to collect and store all data elements. The contractor shall be responsible for monitoring gainsharing arrangements to ensure all demonstration requirements are met and will also monitor the quality of care throughout the demonstration to ensure that the gainsharing arrangements do not compromise the quality of patient care in any way. Through data collection and analysis, the contractor will determine whether internal hospital efficiency has improved as a result of the demonstration. The contractor shall closely monitor Medicare payments to determine whether the demonstration is resulting in an overall reduction of Medicare spending, or has the unintended consequence of leading to an increase in spending such as a shifting of costs from inpatient to post-acute care or ancillary services. Furthermore, the contractor will monitor admission and referral patterns at participating hospitals and neighboring hospitals to ensure that no significant or detrimental changes occur as a result of the demonstration. The implementation/monitoring contractor shall work closely with the evaluation contractor to compliment each other's work and avoid unnecessary duplication of tasks.