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


Conducted on Thursday, July 21, 2011

Recorded event now available

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Program Materials

This CLE webinar 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.

Description

Effective clinical integration of hospital-physician systems will be a core element of healthcare delivery. Providers must transform current systems into integrated healthcare models to meet the incentive requirements established in the Patient Protection and Affordable Care Act (PPACA).

Healthcare providers must also understand the requirements for clinical integration, which is essential for healthcare providers to participate in accountable care organizations (ACOs) and other new public and private healthcare delivery and payment arrangements in the wake of the new PPACA.

Listen as our authoritative panel of healthcare attorneys and advisors examines the key legal and practical implementation issues to ensure effective clinical integration, including compliance with applicable antitrust law, anti-kickback/Stark/CMP law, and exempt organizations requirements under the Internal Revenue Code.

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Outline

  1. Compliance with antitrust law
    1. Limitations on provider network
    2. Core elements of clinically integrated provider network within the meaning of antitrust law
    3. Competitive activities provider participants in a clinically integrated provider network may engage in
    4. Significant of exclusive v. non-exclusive provider network under antitrust law
  2. Issues facing ACOs under
    1. Anti-kickback law
    2. Stark law
    3. Civil monetary penalty
  3. Tax exempt status
    1. Qualification for tax exempt status under section 501(c)(3) or (c)(4)
    2. Structure of service contract arrangements
  4. Practical do's and dont's
    1. Feasibility and gap analysis
    2. Payment and clinical episodes
    3. Infrastructure and data issues
    4. 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
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

Ashley M. Fischer
Ashley M. Fischer

Partner
McDermott Will & Emery

Ms. Fischer's practice is transactional and counseling-based and includes representation of healthcare...  |  Read More

William J. DeMarco
William 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

Joan Polacheck
Joan Polacheck

Partner
McDermott Will & Emery

Ms. Polacheck advises on a variety of healthcare compliance issues, including fraud and abuse and related matters....  |  Read More

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