To establish and grow an effective CIN, participating physicians typically will invest some of their own finances in the form of either initial membership fees or annual fees. Each physician will also provide other resources such as time and energy in order to contribute to the overall goals of the CIN. To help offset the time and financial investment by participating physicians, many CINs have robust financial incentive programs in place. These incentives are commonly based on cost savings and meeting quality metrics set by the CIN. This can help incentivize physicians to utilize the resources provided by the CIN and actively participate in the CIN.
Guidelines for establishing a CIN
Because CINs allow for negotiation with payers for better reimbursement rates, an inherent risk of reducing competition in the marketplace and increasing healthcare costs arises (Brooks, et al). To mitigate this risk, in 1996 the Federal Trade Commission (FTC) provided guidelines (which have since been periodically updated) for establishing healthcare organizations to prevent violations of the Stark Anti-Trust Laws.
- The development and implementation of detailed, evidence-based clinical practice guidelines
- Limiting participation in the program to providers who are committed to accepting the limitations on independent decision-making which the guidelines entail
- Measurement and evaluation of each participating provider’s compliance with the guidelines
- Investment by all participating providers of time, energy and financial resources in the development and enforcement of the clinical guidelines, as well as the computer infrastructure needed to facilitate such integration.
The available legal options for establishing a CIN include physician-hospital organization, independent practice association, or subsidiary of the health system (Butcher). All of these options can be utilized to meet CIN goals and objectives, but each differs in ownership structure and canalization requirements.
If a CIN utilizes partnership with a hospital organization, it is critical that physicians are involved in leading that CIN. This will lead to increased cooperation between hospitals and physicians as well as allow physicians to have a major say in the future directions of the CIN. In addition, working toward the goals and objectives of a CIN will require participating members to change much of their practice including participating in data sharing through EHRs with other members of CINs and changes in referral practices. Physician leadership can also more effectively guide members in implementing these changes into their practice.
Barriers to establishing successful CINs
Because CINs are often comprised of a mix of employed and independent physicians utilizing different EHR systems, pooling data across all providers into one organized, easily accessible database becomes a major hurdle—one that requires significant infrastructure and information technology support to overcome.