Lisa Genecov, Kevin Kroeker, Denise Hanna and Jennifer Rangel will be speaking during the 13th Annual Conference on Emerging Issues in Healthcare Law.
How Integrated Should We Be? Emerging Physician-Hospital Integration and Alignment Models
Lisa Genecov, Moderator
This panel will discuss physician/hospital relationships in the context of ACOs, Co-Management Agreements, Joint Ventures, Clinical Integration and Physician Employment by hospitals and hospital systems, and how reimbursement methodologies such as bundled payments and shared savings might affect the structure of these arrangements. The panel will also cover various federal and state legal issues and impediments to these structures. Regional trends as well as urban/rural trends will be addressed.
Will Payors Rescue Accountable Care?
Kevin Kroeker, Speaker
The much anticipated rule on ACO participation in the Medicare Shared Savings Program landed with an unceremonious thud before most finished their first reading of the proposed rule. While CMS struggles to gain its footing on ACOs, private health plans are heralding a new era of collaboration with physicians and hospitals, and dusting off decadesold risk-sharing models. In August 2011, Anthem Blue Cross of California announced the launch of an ACO with a Silicon Valley IPA consisting of 284
PCPs and 550 specialists that contracts with 10 hospitals; and Blue Shield of California announced an ACO involving three hospitals and six physician groups in Orange County, CA. Blue Shield’s ACO pilot in Sacramento, involving Hill Physicians Group and Catholic Healthcare West, already proved to be a success by improving care and lowering costs for 38,000 retirees enrolled in the CalPERS system. In addition to these alliances, private health plans, both publicly and behind the scenes, have been acquiring ownership stakes in physician groups to re-test the value proposition of integrated healthcare. With private health plans having turned their focus to collaborative care models that offer financial incentives to healthcare providers for achieving better health outcomes and lowering spending, our panel will provide varying perspectives on whether payors, indeed, can rescue accountable care and advance successful care models that are replicable on a broad scale. In doing so, our panel will explore, among other topics:
- Strategic opportunities and challenges for health plans and providers in achieving alignment on successful operating and revenue models.
- Valuation of physician practices and service agreements.
- Hurdles to ownership and employment of physicians in view of the corporate practice of medicine doctrine.
- Downside sharing of financial risk by healthcare providers that may be regulated under HMO and insurance laws.
- Avoiding illegal kick-backs under fraud and abuse laws.
- Avoiding anti-competitive conduct under the antitrust laws.
The Marriage of Quality and Reimbursement: A Match Made in Heaven or a Shotgun Wedding?
Denise Hanna, Speaker
Increasingly, state and federal healthcare programs and commercial payors are tying reimbursement to the satisfaction of certain quality standards. This panel will discuss the intersection of quality and reimbursement, which manifests itself in programs such as value-based purchasing, gain-sharing or shared savings programs, bundled payments and other payment methodologies. The panel will review the legal and operational issues, the impact on physician compensation programs and the standard of care, as well as practical issues from the perspective of physicians, hospitals and health plans.
What’s Inside This Pretty Box? Compliance Issues in Due Diligence
Jennifer Rangel, Moderator
Hear practical advice from experienced transactional attorneys on how to handle compliance issues that arise in due diligence without your deal dying. Understand the sharply different perspectives of seller’s counsel versus buyer’s counsel. Also, hear the perspective of experienced regulatory counsel on the challenges of, and practical strategies for, resolving overpayments, Stark Law violations, HIPAA violations, and other compliance issues given the timing and other constraints of a transaction.
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