Forming Physician Supergroups: Structural and Regulatory Challenges

This CLE course will provide a review of key legal issues involved in forming physician supergroups, including applicable laws and regulations, as well as business considerations. The panel will offer guidance on structuring practice management arrangements and selecting compensation models.

Healthcare organizations are facing increased pressure to improve quality while cutting costs. Physicians are banding together to form supergroups to achieve scale to generate cost efficiencies. Physician consolidation can improve the group's negotiating position with payers and make the provision of ancillary services possible.

However, supergroup formation is not without its challenges. There are structural issues and regulatory hurdles to consider when creating supergroups. The parties should consider the type of entity to form, the impact on reimbursement, and Stark Law requirements.

Another consideration is the application of the Anti-Markup Rule, which prohibits a billing physician or supplier from marking up either the technical component or professional component of a diagnostic test ordered by the billing physician or supplier unless the performing physician shares a practice with the billing physician or supplier.

If the performing physician does not share a practice with the billing physician or supplier, then the rule applies; the healthcare provider/supplier cannot bill Medicare an amount that exceeds payment to the physician.

Listen as our authoritative panel examines the structural and regulatory challenges involved when forming physician supergroups, including Stark and Anti-Markup Rule compliance and the impact of ancillary services.