A long awaited opinion from the OIG on relationships between surgery, endoscopy (and other) centers (“Centers”) will doom many arrangements with anesthesiologists. At the very least, they will have to significantly restructure.
Such “Company Model” arrangements basically involve a way for surgeon investors in Centers to share in the anesthesia services revenue. These arrangements have always been suspect, but the OIG has been clear that they run afoul of applicable federal law. In the June 1st OIG Opinion (12-06), two models were proposed, and both were essentially shot down. The first involved requiring the anesthesiologists who provide services at the Center to engage a management company owned by surgeon owners of the Center to provide management services on a per patient fee basis. The second, which is far more commonplace, involved establishing a company owned by the surgeons who also own the Center. The new company would provide the anesthesia services and contract with the anesthesiologists in a way the leaves some of the anesthesia services income to be distributed to the surgeon in the Center, who also happen to generate all the cases for the Center, and hence all of the anesthesia revenue.
Such arrangements are not only “inherently suspect,” as described by the OIG, they have never made much common sense. How is it not a kickback for the anesthesiologists to make 100% of the anesthesia related profit on Monday, but then have to “share” it with the surgeon owners on Tuesday, once a new management company or separate anesthesia services company (owned by the surgeons) is formed?
At the very least, surgeons looking for a share of anesthesia revenue will have to dig deep into the opinion and into prior opinions to see if there is any legitimate basis available.