Structuring Clinically Integrated Networks: What’s New in 2018 - Evolving Legal Issues, Tax Reform and Other Potential Game Changers

Organization and Governance Issues, Regulatory Requirements, Key Provisions to Position for Success

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

Conducted on Wednesday, February 14, 2018

Recorded event now available

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Program Materials

This CLE webinar will discuss hospital and physician “clinically integrated network” (CIN) organizations in the context of today’s developing payment and delivery system. The panel will discuss CINs in light of payment reform, the evolution of bundled payments, and the changing regulatory environment. The panel will consider the application of various laws and regulations to CINs, including antitrust laws, state and federal restrictions for tax-exempt entities, and fraud and abuse laws, particularly as they pertain to hospital and physician contributions and distributions to CINs.


The Affordable Care Act and its progeny increased attention on quality, cost and value in healthcare delivery in the United States. New emphasis on value has been moving payers, hospitals and health systems to work with physicians to manage costs and improve quality and efficiency. With the proliferation of bundled payments and other value-based payer models, these collaborations have become more important—and complex.

Clinical integration among otherwise separate providers and the operation of CINs is becoming a popular means to pursue cost, quality and value goals. However, CIN formation and operation are large undertakings that require consideration of myriad legal, regulatory and financial factors.

Healthcare counsel must understand the practical aspects of achieving CIN goals, including how clinical integration compares with other strategies to achieve provider cooperation and alignment.

Listen as our authoritative panel of healthcare legal advisers provides a thorough review of CINs, how they differ from other physician-alignment methods, factors to consider when forming or participating in a CIN, organizational structure and governance issues, and regulatory compliance challenges, particularly as they relate to payments to physicians and other CIN participants.



  1. CINs and other alightment and payment methods in a changing environment
  2. Factors to consider when selecting the physician-alignment method platform
  3. CIN organization and governance
  4. Regulatory challenges and opportunities
  5. Best practices for structuring CINs
  6. 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 the Stark and Anti-Kickback Laws, and, when applicable, under laws and regulations related to tax exemption
  • Factors healthcare providers and their counsel should consider when selecting 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


Fadel, Matthew
Matthew Fadel, MSM, MBA
Senior Manager
Dixon Hughes Goodman

Mr. Fadel is a Senior Manager with DHG Healthcare where he focuses on Clinical Integration, Risk Capability,...  |  Read More

Ferrari, Andrea M.
Andrea M. Ferrari, JD, MPH

HealthCare Appraisers

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

Watson, Mark
Mark C. Watson

Hancock Daniel Johnson & Nagle

Mr. Watson focuses on the representation of various providers, including hospitals, health systems, physician groups,...  |  Read More

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