Gainsharing Arrangements and Bundled Payments: OIG Advisory Opinion and Other Developments

Complying With Legal and Regulatory Requirements, Overcoming Implementation and Operational Challenges

Recording of a 90-minute CLE webinar with Q&A


Conducted on Thursday, May 17, 2018

Recorded event now available

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Program Materials

This CLE webinar will provide healthcare counsel with a review of current issues related to gainsharing arrangements and bundled payment programs. The panel will discuss the OIG’s recent advisory opinion on gainsharing arrangements, outline implementation and operational aspects of gainsharing, and offer best practices for hospitals and physicians to minimize legal and business risks.

Description

On Jan. 5, 2018, the OIG issued a new advisory opinion, the first to address a gainsharing arrangement since MACRA modified the gainsharing civil money penalties (CMP). Advisory Opinion 17-09 analyzed a hospital’s payment of a percentage of cost savings to neurosurgeons in a multi-specialty physician group. The OIG approved the arrangement, but made it clear that gainsharing payments must be properly structured and monitored or they will pose risks.

Healthcare counsel face some legal and regulatory hurdles in structuring gainsharing and bundled payment arrangements. These arrangements must be carefully structured to comply with the gainsharing CMP, the Anti-Kickback Statute, and the Stark Self-Referral law either under a traditional fraud and abuse analysis or using the Bundled Payments for Care Improvement (BPCI) waivers. Other legal and business challenges revolve around state laws, provider relationships, insurance markets, and fair market value determinations.

Listen as our authoritative panel examines gainsharing and bundled payment arrangements, the implications of the recent advisory opinion, and the critical operational and regulatory concerns when structuring and documenting these types of arrangements.

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Outline

  1. Bundled payment programs and current CMS initiatives
  2. OIG’s advisory opinion on gainsharing arrangements
  3. Clinical and operational issues in structuring bundled payment and gainsharing models
  4. Legal hurdles to structuring and documenting these types of arrangements
  5. FMV considerations of bundled payment and gainsharing arrangements

Benefits

The panel will review these and other key issues:

  • What are the key operational and regulatory concerns for healthcare providers considering bundled payment and gainsharing arrangements?
  • What are implications of the recent OIG advisory opinion?
  • What critical provisions should counsel document when formalizing these arrangements?
  • What are different types of gainsharing arrangements and what are key features of each?

Faculty

Bernstein, Curtis
Curtis H. Bernstein, CPA/ABV, ASA, CVA, MBA

Principal
Pinnacle Healthcare Consulting

Mr. Bernstein specializes in providing valuation, transaction advisory, strategic and operational consulting services...  |  Read More

Mathias, William
William T. Mathias

Shareholder
Baker Donelson Bearman Caldwell & Berkowitz

Mr. Mathias represents clients across the U.S. in all areas of the health care industry, with a particular emphasis on...  |  Read More

Senn, Girard
Girard F. Senn, RN, MS, NEA-BC

Director
Pinnacle Healthcare Consulting

With more than 30 years of senior management and consulting experience, Mr. Senn adds significant depth and breadth to...  |  Read More

Other Formats
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Strafford will process CLE credit for one person on each recording. All formats include program handouts. To find out which recorded format will provide the best CLE option, select your state:

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48 hours after event

$297

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48 hours after event

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