Physicians and Physician Organizations Law Institute - American ...

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Physicians and Physician Organizations Law Institute Program Agenda R. 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 S. 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 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 T. 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 H. Caught between Scylla and Charybdis: Reconciling Incentive Payments for Value with Government Concerns about Clinical Quality and Overutilization (repeat) 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 U. How Health Reform Has Reduced Fraud Enforcement Risk for Hospitals and Systems (not repeated) 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 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 V. 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 W. 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. The MSO’s Prognosis after the ACA: A Viable Integration Tool? (repeat) M. Complex Fair Market Value/ Commercial Reasonableness Compensation Issues (repeat) 6
Physicians and Physician Organizations Law Institute/ Physicians Hospitals and and Physician Health Organizations Systems Law Institute Law Institute 3:00-4:00 pm F. Staying the Course: Maintaining a Physician Group Practice in Today’s Healthcare Environment (repeat) N. Employer and Employee Perspectives on the Physician Employment Contract (repeat) O. Bundled Payments – Practicalities, Contractual and Governance Issues (repeat) S. Legal Ethics: What Penn State and Lehman Brothers Can Teach Healthcare Lawyers about Conflicts of Interest (repeat) 4:15-5:15 pm P. I’ll Have What She’s Having… Harry Hospital Meets Sally Specialist (repeat) R. Physician Compensation: Legal and Valuation Trends Today, Tomorrow and Beyond (repeat) T. A Practitioner’s Toolkit for Addressing “Technical” Violations of the Stark Law (repeat) W. Clinically Integrated Networks: The PHOs of the 21st Century (repeat) Adjournment 7
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