Structuring and Managing Clinically Integrated Networks – The View From 2019: What’s New and What Do We Do Now?
New Legal and Regulatory Issues for CINs, Organizational Structure, Governance, and More
Recording of a 90-minute CLE webinar with Q&A
This CLE webinar will focus on hospital-physician “clinically integrated network” (CIN) organizations in the context of the evolving legal and regulatory environment, including the 2018 introduction of “Pathways to Success,” the “Regulatory Sprint to Coordinated Care” and court activity that affects interpretations of, and the future of, the Affordable Care Act. The panel will consider the potential effect of pending and evolving legal and regulatory changes to CINs. The panel will discuss Medicare payment rules (including PIP restrictions), Medicare fraud and abuse laws, antitrust laws, state and federal restrictions for tax-exempt entities, and a variety of other state and Federal laws and regulations as they pertain to hospital and physician contributions and distributions to CINs.
- The realities of CINs and other alignment and payment methods in a changing environment
- Factors to consider when selecting the physician-alignment method platform
- CIN organization and governance and current challenges related to an evolving regulatory environment
- Regulatory challenges and opportunities, from PIP restrictions to the potential effect of the “Regulatory Sprint to Coordinated Care”
- Best practices for structuring CINs, as well as in advising them through their lifecycle
- Participant payment issues, including fair market value
The panel will review these and other key issues:
- The place of CINs among various alternative alignment and payment models
- Regulatory challenges CINs face under federal and state law, including the physician self-referral and antikickback laws and regulations, and laws and regulations related to tax exemption
- Factors healthcare providers and their counsel should consider when selecting and then managing a physician-alignment program
- When and why contributions to and payments from a CIN should be fair market value, and factors to consider when making a determination of fair market value
- Special considerations when CIN participants are hospital-employed physicians
Andrea M. Ferrari, JD, MPH
Ms. Ferrari focuses on physician payments related... | Read More
Ms. Ferrari focuses on physician payments related to hospital-physician alignment and efficiency improvement strategies, valuation of services provided by physician-hospital organizations, payments for services provided in connection with clinical research/clinical trial agreements, payments for physician supervision of midlevel practitioners, and health practitioner recruitment and support arrangements. She has provided counsel and representation to various types of clients in the healthcare industry, including hospitals, physicians and physician groups, and pharmaceutical and medical device vendors, distributors, and manufacturers. She works with clients in all 50 states.
Mark C. Watson
Mr. Watson focuses on the representation of various providers, including hospitals, health systems, physician groups,... | Read More
Mr. Watson focuses on the representation of various providers, including hospitals, health systems, physician groups, ambulatory surgery centers, and post-acute care providers, in connection with various transactional, operational, and regulatory matters. He handles transactional matters, including merger and acquisitions of healthcare entities. He also represents health system, hospitals and provider groups in the development and implementation of clinical integration strategies, including the formation of multiple clinically integrated networks taking on a variety of structures, including wholly-owned subsidiaries, hospital-physician joint ventures, and physician-owned networks.Close