Physician-Hospital Clinical Integration: Navigating the Complexities
Structuring Integrated Healthcare Models to Meet Incentive Requirements Under Healthcare Reform
Recording of a 90-minute CLE webinar with Q&A
This CLE course will prepare attorneys for healthcare providers to structure clinical integrations, including complying with applicable antitrust law, anti-kickback/Stark/CMP law, and the requirements under healthcare reform.
Outline
- Compliance with antitrust law
- Limitations on provider network
- Core elements of clinically integrated provider network within the meaning of antitrust law
- Competitive activities provider participants in a clinically integrated provider network may engage in
- Significant of exclusive v. non-exclusive provider network under antitrust law
- Issues facing ACOs under
- Anti-kickback law
- Stark law
- Civil monetary penalty
- Tax exempt status
- Qualification for tax exempt status under section 501(c)(3) or (c)(4)
- Structure of service contract arrangements
- Practical do's and dont's
- Feasibility and gap analysis
- Payment and clinical episodes
- Infrastructure and data issues
- Physicians and hospital alignment
Benefits
The panel will review these and other key questions:
- What are the core elements of a clinically integrated provider network within the meaning of the antitrust laws?
- What issues do ACOs face under anti-kickback and Stark laws?
- How do service contract arrangements have to be structured to avoid jeopardizing the hospital's tax exempt status?
Following the speaker presentations, you'll have an opportunity to get answers to your specific questions during the interactive Q&A.
Faculty
David L. Klatsky
Partner
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.
CloseAshley M. Fischer
Partner
McDermott Will & Emery
Ms. Fischer's practice is transactional and counseling-based and includes representation of healthcare... | Read More
Ms. Fischer's practice is transactional and counseling-based and includes representation of healthcare organizations. Her transactional practice includes mergers, acquisitions and affiliations; divestitures; hospital/physician joint ventures and corporate reorganization. Her regulatory practice focuses on antitrust; the Anti-Kickback and Stark laws; health information privacy; and other regulatory matters.
CloseWilliam J. DeMarco
President
Pendulum Healthcare Development
He has over 30 years of experience in health plan development and management consulting and provides in depth analysis... | Read More
He has over 30 years of experience in health plan development and management consulting and provides in depth analysis and decision support tools to determine root cause of utilization and cost, support predictive modeling and moving providers to a platform of clinical integration including Accountable Care Organization development and performance based contracting.
CloseJoan Polacheck
Partner
McDermott Will & Emery
Ms. Polacheck advises on a variety of healthcare compliance issues, including fraud and abuse and related matters.... | Read More
Ms. Polacheck advises on a variety of healthcare compliance issues, including fraud and abuse and related matters. She assists healthcare providers and drug and device companies to perform “legal audits” and to establish and implement compliance programs and related policies. She also has extensive experience in managed care contracting on behalf of healthcare providers.
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