Physicians and Physician Organizations Law Institute - American ...

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Hospitals and Health Systems Law Institute 11:25 am-12:25 pm F. Buyer Beware! The Value of Due Diligence in Hospital-Physician Transactions (not repeated) Lori A. Foley Judd A. Harwood j Practical regulatory, financial and transactional issues both in‐house and outside counsel need to navigate when evaluating physician‐provider transactions j Identification of economic and operational issues that should be evaluated preacquisition j Importance of evaluating documentation, coding and billing compliance j Identification of common diligence issues and strategies for resolving uncovered regulatory problems, including voluntary self‐disclosures G. Consolidation in a Rapidly Changing Industry: Navigating Options, Antitrust and Other Obstacles David A. Ettinger Lynn Gordon j Consolidation drivers j The range of hospital/health system collaboration and consolidation models; key components of each model j Legal hurdles and requisite regulatory approvals, with strategic guidance, leading into a more in-depth antitrust discussion j Viability of “3 to 2” and “4 to 3” mergers after Toledo and Rockford: Are they dead? j Antitrust limits on hospital acquisitions of physician practices j Strategic guidance on navigating an antitrust sensitive transaction j Sample transaction overview: a change of control/membership Substitution; key steps and parallels to other models, with a timeline H. Physician Compensation: Legal and Valuation Trends Today, Tomorrow and Beyond Kimberly A. Mobley Claire M. Turcotte j Compensating physicians for quality, performance—how, when and why? j Compensating for administrative services j When do hours need to be tracked (and how)? j Compensation and FMV challenges in alignment strategies: – Co-management arrangements – Professional services arrangements – Income support arrangements j Operational challenges when changing the physician compensation plan j Best practices for governance and approval, and monitoring of physician compensation arrangements Program Agenda J. Legal Ethics: What Penn State and Lehman Brothers Can Teach Healthcare Lawyers about Conflicts of Interest William W. Horton Jeff Sconyers j Conflict rules under the Model Rules of Professional Conduct j Conflicts: Waivable and the other kind 10 j Representing an entity vs. advising individual stakeholders j Separate representation, indemnification and advancement of expenses j Lessons from Penn State, Lehman Brothers and other cases K. A Practitioner’s Toolkit for Addressing “Technical” Violations of the Stark Law Kristin M. Bohl Robert D. Stone j Some of the most common technical violations that occur j Approaches for analyzing the facts to determine if a violation exists or if an arrangement may be compliant j If you decide a violation exists, what is the self-disclosure process j The Voluntary Physician Self-Referral Disclosure Protocol, including the process, best tips when submitting a disclosure and potential pitfalls to avoid 12:25-1:35 pm Lunch on your own or attend a Practice Group Luncheon: Medical Staff, Credentialing, and Peer Review, sponsored by MDReview, or Hospitals and Health Systems/ In-House Counsel/Enterprise Risk Management Task Force (joint luncheon) sponsored by Health Capital Consultants LLC (additional fee; limited attendance; pre-registration required; see page 19 for the descriptions and pages 21-22 to register) CONCURRENT SESSIONS 1:45-2:45 pm L. Physician and Hospital Investment in Ambulatory Surgery Centers (not repeated) Melissa S. Szabad Martha J. Talley j Application of the anti-kickback law and safe harbor to physician and hospital investment in ASCs j Conversion of ASCs to hospital out-patient departments M. The Top 10 Conflicts of Interest Developments Healthcare Lawyers Need to Know About Gregory S. Radinsky j New laws and industry guidance on Conflicts of Interest and Gifts j Tips to avoid Stark and Anti-kickback issues j Practical tips for on auditing and monitoring for compliance with your Conflicts of Interest and Gifts policy j Pitfalls to avoid in implementing a more stringent Conflicts of Interest policy N. How Health Reform Has Reduced Fraud Enforcement Risk for Hospitals and Systems Patrick S. Coffey Linda A. Wawzenski j The cases for and against the position that PPACA has brought about a fundamental shift in fraud enforcement focus and initiatives relating to physicians and physician groups
Hospitals and Health Systems Law Institute j The enforcement data and trends relating to the FCA, Anti‐Kickback and Stark cases being pursued against physicians and groups j The impact of Post‐PPACA enforcement trends and government initiatives on physician compliance efforts and programs j Comparison of recent/past cases involving alleged healthcare fraud by physicians and physician groups j Best practices for avoiding enforcement, exclusion and other fraud related risks to physicians and groups j The future of healthcare fraud enforcement O. Clinically Integrated Networks: The PHOs of the 21st Century Peter A. Pavarini Michael F. Schaff j Clinically integrated networks, if properly structured and operated, can avoid the regulatory and financial mistakes made by PHOs in the past j Existing clinically integrated networks, demonstrate how these organizations have promoted better care at lower cost, offering a compelling value proposition to payers in their markets j Contemporary governance structures and contractual provisions can address the competing interests of physicians who wish to preserve their independence with a hospital’s expectation of loyalty to the goals and objectives of the organization j The challenges and opportunities presented by clinically integrated networks when they seek to negotiate enhanced payment arrangements with payers in order to share in the value created by coordinated care j Apply these concepts and strategies to factual scenarios where physician employment is not an option or has been tried unsuccessfully B. Complex Fair Market Value/ Commercial Reasonableness Compensation Issues (repeat) 3:00-4:00 pm P. Hospital Acquisition of Physicians Groups William E. Berlin John P. Wiegand j The structural divestiture remedy in Renown Health, contrast to recent AG conduct remedies in the MaineHealth and UCPA physician mergers j The effect of healthcare reform and changing market dynamics on merger activity, including the interplay with Accountable Care Organizations (ACOs) and their implementing regulations – do the goals and mechanisms of healthcare reform and market reality conflict with agency merger enforcement? j Unique market definition and market power issues in physician services markets – how useful is historical and often limited patient data? Is market concentration a reliable tool for determining whether the parties will exercise market Program Agenda 11 power, especially in consummated mergers? How should coordinated effects and vertical foreclosure issues be analyzed? j Practical issues in merger implementation and defending agency investigations: Payor communications, community commitments, hold separate agreements, CID compliance and document preservation and production j FTC and AG enforcers’ perspective on substantive analysis and remedies in hospital-physician mergers Q. OIG Enforcement Initiatives Relating to Hospitals S. Craig Holden Lewis Morris j Recent False Claim Act cases – Stark/Kickback cases – Short stay cases j OIG Audit initiatives j OIG Self‐Disclosure Protocol j Mandatory repayment rules C. Employer and Employee Perspectives on the Physician Employment Contract (repeat) D. Bundled Payments – Practicalities, Contractual and Governance Issues (repeat) J. Legal Ethics: What Penn State and Lehman Brothers Can Teach Lawyers about Conflict of Interest (repeat) 4:15-5:15 pm R. Knowing When and How to Protect Quality Information in an Employed Physician World Catherine M. Ballard Barbara Harbor Evert j Effectively triaging quality concerns/professional behavior concerns with employed physicians in both the hospital and office settings (e.g., quality of care, professional behavior, compliance, contract, etc.) j Conducting peer review of employed physicians in the nonhospital setting j Creating processes that permit sharing of protected peer review information beyond the entity employing the physicians to include other organizations within a system j Looking at the risks that need to be assessed if certain information is not shared within a system (or can be shared, but not peer review protected) j Creating processes that take advantage of a state peer review privilege, to the extent possible S. Strategies Behind Successfully Resolving Compliance Issues and Government Investigations Brian D. Roark Richard L. Shackelford j Disclosure strategies for complex overpayment issues j Disclosure strategies tailored to address issues unique to potential stark violations
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