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Clinically Integrated Networks in a Value-Based Care World and the New Regulatory Landscape: What You Need To Know
Legal and Regulatory Issues for CINs, Organizational Structure, Governance, and More
Welcome! Save 30% on all CLE, CPE, and Professional Skills webinars, plus 15% off any annual pass with code CYBER2025
About the Course
Introduction
This CLE course will address legal, regulatory and market changes that are important to the future formation and operation of hospital-physician clinically integrated networks (CINs) and Accountable Care Organizations (ACOs). The topics will include recent regulatory activity and changes in key aspects of federal and state antitrust law, healthcare fraud and abuse laws, information privacy and data sharing regulations, corporate practice of medicine and fee splitting restrictions, and state and federal tax law. The course will provide an opportunity for Q&A to allow listeners to focus the discussion on what is most relevant to them.
Description
The growing need for value-based care delivery has been driving stakeholders across the healthcare industry to collaborate and transact in innovative ways to manage costs and improve quality and efficiency in healthcare delivery. With the recent proliferation of risk-based payment models and the stressors and resource limitations of provider shortages, providers of all types are exploring options to simultaneously improve quality, lower cost and improve population health. Against the backdrop of new regulations from multiple government agencies, several recent large CIN and ACO transactions provide interesting lessons for providers considering similar collaborations.
Listen as our authoritative panel of experts provides an in-depth discussion of new legal developments affecting CINs and similar structures, how the regulatory questions and answers for these types of physician-alignment structures may differ going forward, and what physicians, hospitals, payors, care navigators and ancillary parties may need to consider when planning participation in a CIN.
Presented By
Ms. Compton is a trusted advisor to clients ranging from traditional health care providers to disrupter digital health platforms as they navigate the practical and regulatory challenges of health care innovation. She counsels telemedicine and other digital health clients on business plan strategy and implementation, state-specific telemedicine regulation, corporate practice of medicine, the scope of practice, fee splitting, anti-kickback, reimbursement, and other health care regulatory issues. Leveraging her prior in-house experience at two nonprofit health systems, Ms. Compton also advises health care providers on the incorporation of telehealth and other technology infrastructures, which has seen a vast uptick as a result of the COVID-19 pandemic. She advises health care providers, clinical trials companies, ancillary providers, technology start-ups, HMOs, insurance companies, and large technology companies on HIPAA and other health data privacy and security regulations, including developing and implementing HIPAA compliance programs. She has also led significant HIPAA breach investigations, advising clients on risk management and mitigation efforts.Member
Ms. Ferrari is a member of Hancock Daniel’s corporate healthcare group, where she focuses on issues related to transactional and enterprise compensation planning, governance and review, particularly issues related to fair market value and commercial reasonableness. Although her past experience encompasses a multitude of regulatory, transactional, governance and investigation matters, Ms. Ferrari is known especially for her work in recruitment and retention of highly compensated thought leader physicians and executives; and incentive payment distributions through ACOs and clinically integrated networks to advance value-based care initiatives. She has worked extensively with clients navigating the intersection of regulatory and financial considerations in clinical research, including agreements for funding and support services and the related issues of contracting and compliance; transactional due diligence for compensation compliance; and navigating the intersection of compensation and antitrust issues. Ms. Ferrari's expertise also includes recruitment, compensation and procurement governance for “essential” hospitals such as public, rural, academic and pediatric hospitals.
Mr. Watson focuses on the representation of various providers, including hospitals, health systems, physician groups, ambulatory surgery centers, and post-acute care providers, in connection with various transactional, operational, and regulatory matters. He handles transactional matters, including merger and acquisitions of healthcare entities. He also represents health system, hospitals and provider groups in the development and implementation of clinical integration strategies, including the formation of multiple clinically integrated networks taking on a variety of structures, including wholly-owned subsidiaries, hospital-physician joint ventures, and physician-owned networks.
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This 90-minute webinar is eligible in most states for 1.5 CLE credits.
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Live Online
On Demand
Date + Time
- event
Thursday, August 24, 2023
- schedule
1:00 p.m. ET./10:00 a.m. PT
- Overview of selected key recent and proposed changes and case law developments in Federal and state antitrust law, healthcare fraud and abuse laws, payor regulations, information privacy and data sharing, corporate practice of medicine restrictions, and state and federal tax law
- Current and future organizational and governance issues in the evolving regulatory environment, including issues related to monitoring and maximizing participant financial incentives while ensuring compliant, fair market value and commercially reasonable payments
- What can be learned from recent case law and examples in the market
- Suggestions for best practices going forward, including for information tracking and payments of incentives and distributions
The panel will review these and other key issues:
- Regulatory and compliance questions CINs face under new Federal and state laws and regulations, including the physician self-referral, anti-kickback, antitrust, corporate practice of medicine, fee splitting and tax exemption laws and regulations
- Factors healthcare providers and their counsel should consider when selecting and managing value-based population health incentive programs in 2023
- When and why contributions to and payments from a CIN should be evaluated for fair market value and reasonableness
- Special considerations when CIN participants are hospital-employed physicians, not-for-profit entities and/or private equity investors
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