Accountable Care Organizations: Proposed Regulations Finally Released
Preparing for Significant Regulatory Changes and Anticipating Antitrust, Fraud, Patient Privacy and Stark Law Pitfalls
Recording of a 90-minute CLE webinar with Q&A
This CLE course will provide guidance provide guidance on navigating the new proposed regulations for accountable care organizations (ACOs), including identifying and responding to the potential regulatory and practical obstacles when forming an ACO, and what components of the regulations are likely to draw formal comments and why.
- Proposed ACO regulations
- ACO governance and legal organization options
- Are 5000 minimum ACO beneficiaries sufficient? Is $1.75 million start-up cost realistic?
- Influence of MedPac’s recommendations on the proposed ACO regulations
- One-sided risk parameters
- Specific requirements regarding primary care physicians and other ACO physicians
- Medicare beneficiary's freedom of choice of physicians and other providers and controversial data-sharing patient opt-out right (ACO disclosure requirements and implications for ACO shared savings and two-sided risk model)
- Two-sided risk parameters and potential impact of state HMO/insurance law
- Impact of other federal laws on ACOs and proposed waivers/exceptions
- Antitrust law
- Anti-kickback laws
- Civil monetary penalty law
- Tax law
- Provider payment strategies
- Reimbursement continuum
- Payment models and developmental capabilities
- Bundled payments and episodes of care
- Combined bottom-line payment model
- Continuum of clinical care management
- Provider-payer care coordination focus
The panel will review these and other key questions:
- What factors should healthcare providers consider when assessing participation in ACOs?
- What does the proposed rule require for ACOs to take responsibility for improving the quality of care while lowering costs in order to receive a share of the resulting savings?
- What are the legal obstacles that healthcare providers must overcome to participate in ACOs?
Following the speaker presentations, you'll have an opportunity to get answers to your specific questions during the interactive Q&A.
J. Peter Rich
McDermott Will & Emery
Mr. Rich practices almost exclusively in the healthcare field, advising hospitals, medication groups, and health plans,... | Read More
Mr. Rich practices almost exclusively in the healthcare field, advising hospitals, medication groups, and health plans, as well as health industry clients. He has formed and restructured many types of managed care organizations, including ACOs, other types of physician-hospital organizations and similar integrated healthcare delivery systems, as well as HMOs and other types of health plans.Close
David L. Klatsky
McDermott Will & Emery
He has 20 years of experience in health industry mergers and acquisitions, with a focus on the transactional and... | Read More
He has 20 years of experience in health industry mergers and acquisitions, with a focus on the transactional and regulatory aspects of promoting collaboration among providers. He has recently been retained by a leading national healthcare improvement alliance to advise its members regarding the formation of accountable care organizations. He is a frequent speaker on provider integration strategies.Close
He has 35 years of experience as a management consultant to hospital systems, integrated delivery networks, health... | Read More
He has 35 years of experience as a management consultant to hospital systems, integrated delivery networks, health plans, employers and technology companies. He has written numerous books on healthcare delivery, clinical practice, and management and market strategy. He focuses on designing and implementing effective client deliverables for providers and payers.Close