Physicians and Physician Organizations Law Institute - American ...

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Physicians and Physician Organizations Law Institute Program Agenda j Compensation formulas designed to align with practice goals j Key corporate documents, including buy-in/buy-out provisions, restrictive covenants , dispute resolution, and governance and decision-making 12:15-1:35 pm Lunch on your own or attend a Practice Group Luncheon: Antitrust; Physician Organizations, sponsored by PYA; or Labor and Employment (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 G. Building a Practice Acquisition and Employment Strategies that Stand the Test of Time in a Changing Regulatory Environment Christopher T. Carnahan David T. Lewis j Legal requirements applicable to practice acquisitions j The roles and responsibilities of client business representatives, legal counsel and valuation professionals j Reasons why practice acquisitions fail and how failures can be avoided j Building a strategic plan for practice acquisitions and hospital‐physician alignment H. Caught between Scylla and Charybdis: Reconciling Incentive Payments for Value with Government Concerns about Clinical Quality and Overutilization Daniel F. Murphy Bruce J. Toppin j Use of a service line co-management agreement with pay for performance and gainsharing elements as a case study, focusing on areas of tension between the current drive for value and existing regulatory guidance j Ideas to address these tensions in ways that satisfy quality and cost objectives, while minimizing regulatory risk j Quality of care metrics tied to P4P incentive payments and identify guidelines for providing clinical justification for selecting those metrics j Gainsharing categories and identify controls and safeguards that can be implemented to prevent and detect quality of care concerns J. Reimbursement: Getting Physicians Paid Andrew H. Selesnick j Determining and collecting usual, customary, and reasonable charges for non-contracting physicians j Managed care and payor contracting tips j Litigating against payors j Coding and documentation issues j Preparing for and defending government and payor reimbursement audits 4 3:00-4:00 pm K. A 12-Step Program to Better Compliance: A Practical Approach Julie E. Kass Kim Harvey Looney j Steps providers need to take to have an effective compliance plan j Strategies to deal with real life compliance issues C. The Evolution of HIPAA: Impact of HITECH and Increased HIPAA Enforcement on Physician Practices (repeat) J. Reimbursement: Getting Physicians Paid (repeat) 4:15-5:15 pm A. A Marketing Compliance Primer for Healthcare Providers (repeat) E. How to Determine Commercial Reasonableness of Hospital-Physician Compensation Arrangements (repeat) G. Building a Practice Acquisition and Employment Strategies that Stand the Test of Time in a Changing Regulatory Environment (repeat) 5:15-6:15 pm Networking Reception, sponsored by HORNE LLP (attendees, faculty and registered spouses and guests welcome) 6:15-7:15 pm Celebrating Diversity and Inclusiveness Reception, sponsored by AHLA’s Advisory Council on Diversity (attendees, faculty and registered spouses and guests welcome) Tuesday, February 12, 2013 7:00 am-5:15 pm Registration and Information 7:00-8:00 am Continental Breakfast, sponsored by HORNE LLP (attendees, faculty and registered spouses and guests welcome) General Session 8:00-8:15 am Welcome and Introduction Kristen B. Rosati, AHLA President-Elect Lisa J. Gilden, Hospitals Program Co-Chair 8:15-9:45 am Top Legal Developments for Hospitals and Physicians Elizabeth B. Carder-Thompson Jack S. Schroder, Jr.
Physicians and Physician Organizations Law Institute Program Agenda CONCURRENT SESSIONS 10:15-11:15 am L. Why Quality of Care Should Matter to You: FCA Enforcement in 2013 and Beyond (not repeated) George B. Breen Kevin A. Cornish Jeffrey Dickstein j The government’s theory of FCA liability in “quality of care” and “worthless services” cases against hospitals and against individual physicians j Challenging the government’s effort to utilize the False Claims Act as a mechanism to enforce quality standards j What providers and hospitals can do proactively, to try to stave off this enforcement effort and how compliance programs should be adapted to address this risk area M. Complex Fair Market Value/ Commercial Reasonableness Compensation Issues Robert A. Wade j Compensation stacking j How to apply benchmark data j When is it safe to exceed the benchmark data range? j Call compensation issues j How to apply commercial reasonableness to compensation arrangements – including shifting of business risk j Productivity compensation issues j Mid-level provider supervision compensation j Stipends for hospital-based services (ER, Anesthesiology, Hospitalist, Radiology) j Real estate – what is a defensible market assessment and how to apply j Time share leasing arrangements – how to develop and manage compliant arrangements N. You Say Tomato: Employer and Employee Perspectives on the Physician Employment Contract Philip M. Bluestein Martha S. Henley j Generic/standard physician employment contract j Contentious issues from the employer’s and employee’s counsel’s perspective j Non-competition and non-solicitation provisions j Medical records – ownership, disclosure, appropriate access to and use of during and post-employment j Government audits and recapture of funds from employed physicians j Intellectual property j Issues surrounding moonlighting and other outside employment opportunities j Meaningful use j Compensation structures j Offsetting compensation for funds owed O. Bundled Payments – Practicalities, Contractual and Governance Issues Alice G. Gosfield j Defining terms: Bundles vs episodes vs. gainsharing, etc j What do we really know about bundled payment? Experiences to date j Principles of bundling: Triggering, breaking, ending j How bundles affect governance and contracting j Governance among participating providers: Avoiding food fights, sueprmajorities, adding, terminating participants j Dispute resolution P. I’ll Have What She’s Having… Harry Hospital Meets Sally Specialist Robert G. Homchick Cynthia Y. Reisz j Integration options and the factors driving how and to what degree hospitals and specialists are coming together j Use of hypotheticals to explore: – Professional Services Agreements in combination with Management Services Agreements – Innovative models facilitating Hospital or Physician Network participation in or ownership of traditional Physician practices K. A 12-Step Program to Better Compliance: A Practical Approach (repeat) 11:25 am-12:25 pm Q. 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 pre-acquisition 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 5
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