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


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.

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?

Faculty

David L. Klatsky, Partner
McDermott Will & Emery, Los Angeles

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.

Ashley M. Fischer, Partner
McDermott Will & Emery, Chicago

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.

William J. DeMarco, President
Pendulum Healthcare Development, Rockford, Ill.

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.

Joan Polacheck, Partner
McDermott Will & Emery, Chicago

She 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.


Recordings

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Customer Reviews

I thought the webinar was timely and relevant.  Great speakers and excellent information.

Nancy Sever

Crystal Run Healthcare

The content covered was relevant and timely.

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Alvarez and Marsal

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Rose, Sundstrom & Bentley

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Miller Thomson

I thought the seminar was at exactly the right level.

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Health Law Advisory Board

Lowell C. Brown

Partner

Arent Fox

Jennifer L. Evans

Shareholder

Polsinelli

Ryan S. Johnson

Shareholder

Fredrikson & Byron

Gina M. Kastel

Partner

Faegre Baker Daniels

Karen S. Lovitch

Member

Mintz, Levin, Cohn, Ferris, Glovsky and Popeo

David A. Manko

Partner

Rivkin Radler

John J. Miles

Principal

Ober Kaler

C. Elizabeth O'Keeffe

Counsel

Wyatt, Tarrant & Combs

J. Peter Rich

Partner

McDermott Will & Emery

Donald H. Romano

Of Counsel

Foley & Lardner

Judith A. Waltz

Partner

Foley & Lardner

John R. Washlick

Shareholder

Buchanan Ingersoll & Rooney

Jesse A. Witten

Partner

Drinker Biddle & Reath

or call 1-800-926-7926

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