Saint Louis University Journal of Health Law & Policy

Document Type



An often overlooked provision in the Patient Protection and Affordable Care Act is the authorization of demonstration projects which incentivize providers to develop, implement, and test novel, cost-cutting approaches to care delivery. One such project, the Comprehensive Care for Joint Replacement demonstration project, encourages providers across the continuum of care to collaborate on strategies that improve the quality of and lower the cost of complete joint replacements. The project allows providers to share the benefits of cost savings, and liabilities for cost overruns, across the surgeons performing procedures, acute care facilities, and post-acute care facilities. Arrangements of this type, outside of the demonstration project, could potentially expose participants to liability under federal laws prohibiting certain financial relationships between providers. It is therefore important to understand the regulatory implications for the creation and operation of provider networks. It is also possible these relationships may need to be unwound if the demonstration project were to end. Finally, it is also possible these models may be adopted outright and become permanent programs. This article will explore the underlying regulatory structure implicated in cost-sharing arrangements with a focus on those potential issues implicit in the Comprehensive Care for Joint Replacement demonstration project.