Care Coordination, Clinical Integration, Group Practices, and Research: Designing Healthcare Provider Incentives
Course Details
- smart_display Format
On-Demand
- signal_cellular_alt Difficulty Level
Intermediate
- work Practice Area
Health
- event Date
Thursday, March 7, 2024
- schedule Time
1:00 p.m. ET./10:00 a.m. PT
- timer Program Length
90 minutes
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This 90-minute webinar is eligible in most states for 1.5 CLE credits.
This CLE course will guide healthcare counsel and advisers on the emerging trends in financial incentives for physicians and other providers and the pitfalls in properly documenting, structuring, and implementing them. The panel will review the relevant changes to the Stark Law and Anti-Kickback Statute regulations, the implications for physician incentives, and the different regulatory structures under which healthcare organizations must operate in 2024 and forward.
Ms. Ferrari has more than 25 years of experience in the healthcare industry in various counsel, consulting and leadership roles. She serves clients inside and outside of Pinnacle, providing assistance with compliance strategy, risk management, due diligence, investigations, and litigation.
Her practice experience is national in scope and includes providing transactional, operational, governance, and dispute resolution support for a broad array of nonprofit, for-profit, and governmental clients, including hospitals and health systems, physicians and physician groups, clinical laboratories, and pharmaceutical and medical device vendors, distributors, and manufacturers. She has assisted clients with structuring, documenting, managing, and, when appropriate, defending financial arrangements involving healthcare providers, often with attention to requirements and implications of the Stark Law, Anti-kickback Statute, False Claims Act, non-profit tax regulations, Foreign Corrupt Practices Act and/or the various state laws concerning billing, payment and corporate practice of medicine. Her work has included assisting clients with mergers and acquisitions, affiliations, joint ventures, public-private partnerships, enterprise-level compliance programs, and healthcare workforce recruitment and management arrangements, including significant incentive, independent contractor, and employment arrangements that exceed $1 million in annual compensation. Her work has also included outside general and special counsel services for healthcare clients, focusing on their contracting and compensation practices.
Ms. Jacobs focuses her practice in the area of healthcare transactions. Calling upon her years of dedicated experience, she provides practical, pragmatic advice to help her clients achieve their strategic goals. Within the highly regulated health care industry, Ms. Jacobs advises clients, including hospitals, health systems, AMCs and large physician groups, on transactions. She serves as a regulatory adviser, providing fraud and abuse analysis in the context of a deal and ensuring her clients remain compliant with the regulations that govern health care transactions.
The healthcare industry continues its shift from measuring and paying for the volume of care provided to emphasizing and tying payment to the value of care provided. With this shift, healthcare provider contracts and transactions increasingly include financial incentives that are to encourage coordinated and targeted efforts toward improving measures of quality and cost. Although such financial incentives are generally considered reasonable and even necessary to achieve the socially desired changes in provider practices and behaviors, they remain fraught with potential regulatory pitfalls, even after the new compliance options introduced through the Regulatory Sprint to Coordinated Care.
In many ways, the COVID-19 public health emergency and related challenges dramatically shifted our understanding of value in healthcare delivery, and likewise the goals and targets for provider financial incentives. Work RVUs and work hours have been replaced or significantly supplemented by measures of panel size, quality, and cost effectiveness. Traditional measures of good provider citizenship, such as participation in continuing education or outreach, are being replaced or supplemented by targets for advancing or participating in clinical research or care management initiatives.
At the same time, both related and unrelated regulatory and market changes have dramatically altered the data and "rules of the road" that may be relied upon for structuring compensation and service arrangements with physicians and other providers.
Listen as our authoritative panel of healthcare attorneys updates their prior programs in this topic and examines the emerging trends and pitfalls in designing and implementing financial incentives for physicians and other providers, including in the context of care coordination, clinical integration, primary care, medical research, and newer and emerging strategies to promote principles of equity and inclusion for both patients and caregivers.
- Emerging trends and focus areas for healthcare provider financial incentives, including new "care team" bonuses allowed for group practices and rules about group practice protection for value-based enterprise profits
- Old and new pitfalls in documentation, structure, and implementation, as evidenced through case law and regulatory guidance
- Commercial reasonableness and FMV after Stark Law and AKS Final Rules, including how these concepts and their importance have changed (and also how they haven't changed)
- Best practices for avoiding pitfalls in the design and structuring of incentive compensation arrangements
The panel will review these and other key issues:
- What are the recent trends in physician incentives?
- What steps can healthcare advisers take to ensure regulatory compliance when structuring physician incentives?
- What are the implications for compliance with the Stark Law, the AKS, tax exemption and public entity laws, and other laws and regulations?
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