Structuring and Implementing Physician Incentives in the Age of COVID-19

Understanding New Regulatory Compliance Pitfalls and Long Term Implications

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


Conducted on Thursday, June 25, 2020

Recorded event now available

or call 1-800-926-7926
Program Materials

This CLE webinar will guide healthcare counsel on physician incentives, examining the legal requirements and the potential risks. The panel will compare current incentives and value-based incentives and discuss the impact on regulatory compliance. The panel will offer best practices for structuring physician incentives.

Description

The healthcare industry has been steadily shifting from reimbursement based on volume of services to value of care provided. To keep pace with this shift, provider contracts and transactions have increasingly included financial incentives to encourage coordinated efforts toward improvement on measures of value in care delivery. To accelerate the shift, the Department of Health and Human Services issued new and highly anticipated changes to the rules promulgating the Stark Law and Antikickback Statute in October of 2019. While the proposed rule changes have fostered both uncertainty and a call to action in anticipation of their finalization, the COVID-19 public health emergency, which has redefined the healthcare questions for 2020, has added an additional layer of complexity.

Financial incentives are reasonable and even necessary to achieve changes in provider practices and behaviors to meet the demands of value based care, but they are fraught with potential financial and regulatory pitfalls especially in the current environment. Several recent court cases and government publications illustrate why incentives that are not carefully considered in the context of facts and circumstances can lead to legal troubles, particularly with respect to the important regulatory “rules” of ensuring that financial arrangements are fair market value (FMV), commercially reasonable and not improperly based on volume or value of referrals.

Listen as our authoritative panel of healthcare legal advisers discuss emerging trends and hot button questions in financial incentives for physicians and other providers and the pitfalls in properly documenting, structuring and implementing them. The panel will offer guidance based on:

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Outline

  1. Review of typical physician incentive arrangements and how the proposed rules as well as the COVID-19 emergency may affect them
  2. The current and evolving regulatory environment and the dangers in improperly structured incentive arrangements in this environment, including:
    1. New (and unchanged) standards of what is FMV, commercially reasonable and/or improperly based on volume or value of referrals; and
    2. Recent court cases, regulatory enforcement and other government actions that are illustrative of the pitfalls of certain types of incentives in the current environment, including those that on their face may seem reasonable.
  3. Observations and best practices for avoiding pitfalls in the design and implementation of incentive arrangements in the age of COVID-19.

Benefits

The panel will review these and other key issues:

  • What steps can healthcare advisers take to ensure regulatory compliance when structuring physician incentives?
  • What are the implications for compliance with the Stark Law, the AKS, and other laws and regulations?
  • What lessons can healthcare counsel take away from recent enforcement actions?

Faculty

Ferrari, Andrea
Andrea M. Ferrari, JD, MPH

Partner
HealthCare Appraisers

Ms. Ferrari focuses on physician payments related to hospital-physician alignment and efficiency improvement...  |  Read More

Jacobs, Clevonne
Clevonne M. (Vonne) Jacobs

Principal & Founder
PHAROS Healthcare Consulting

Ms. Jacobs provides strategic and operational advisory services to for-profit and nonprofit healthcare organizations....  |  Read More

Razdan, Neerja
Neerja Razdan

Associate Counsel
Beaumont Health

Ms. Razdan is Associate Counsel with the Beaumont Health. She has experience focusing on a wide range of physician and...  |  Read More

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