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Description<br>In this session Mr. Wolfe will provide a straight-forward, practical explanation of developing concepts, including the quality and value metrics into new federal health care programs and commercial payment systems, new delivery models, what providers can be doing to develop a value-based strategy, and the application of the Stark Law and other fraud and abuse laws to new models aimed at population health, quality of care and cost control. Mastering these concepts will be a must for healthcare executives looking to position their organizations for success in this new value-based world.<br><br>Why Should you attend:<br><br>Medicare, Medicaid, and private payors are looking to accelerate the transition from volume to value and population health through targeted incentives. <br>Going forward, healthcare leaders should be developing a value-based strategy so they can position their organizations for financial success in the new value-based world.<br>A refined and comprehensive value-based strategy can advance several important goals for a healthcare organization, among them<br>enhancement of quality of care and improvement of patient outcomes.<br> promotion of safe medical practices;<br>sharing of best clinical practices;<br>increased efficiencies in care delivery;<br>facilitation of appropriate utilization of services; and<br>alignment of financial incentives.<br>Attendees should register for this webinar to get a better understanding of the legal issues surrounding paying for quality and value so they can refine their current strategy and can identify new delivery models and potential opportunities. <br>Areas Covered in the Session:<br><br>Provide a general overview of new quality and value-based payment trends<br>Discuss CMS’s new Quality Payment Program, its pathways and potential options for clinicians as they navigate the program. <br>Discuss potential strategies for incentivizing physicians in connection with the rollout of the new value-based programs<br>Discuss the application of the existing regulatory framework (e.g, AKS, Stark, CMP, beneficiary inducement, etc. ) to new models aimed at incentivizing population health, quality of care and cost control.<br>Background:<br><br>It’s clear that health care reform and new payment trends are leading hospitals, health systems, and medical groups to consider new compensation models to enhance their capabilities in providing value-based care, cost management and improved quality and efficiency.<br><br>E-mail us at cs@onlineaudiotraining.com or Call 1-800-935-3714 to buy full webinar.
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Paying Health Care Providers for Quality and Value Key Trends and Stark Law Considerations Presented by Joseph N. Wolfe
Joseph Wolfe is a partner with Hall Render, the largest health care focused law firm in the country, now with offices nationwide. Hall Render attorneys provide advice and counsel to some of the nation's largest health systems, hospitals and medical groups on a broad range of regulatory, operational and strategic matters. Mr. Wolfe regularly counsels clients on a national basis regarding compliance-focused physician compensation strategies. He is a frequent speaker on issues related to the physician self-referral statute (Stark Law), hospital-physician transactions, physician compensation and health care fair market value issues. Before attending law school at the University of Wisconsin, he served as a combat engineer in the United States Army. Recent presentations specific to health law include: . • A Fair Market Value Primer for Health Lawyers and Compliance Officers - AHLA Fraud and ComplianceInstitute (October 4, 2017) Baltimore,MD. • How to Use and Not Abuse MGMA and Other Survey Data in FMV Compliance Programs – AHLA Physicians and Hospitals Law Institute (February 1, 2017) Orlando, FL. • 2016’s Acronym Soup: CJR, BPCI, OCM, MIPS, and APMs, What Do They Mean for FMV and Reasonableness in Compensation – AHLA Webinar(December 6, 2016). Joseph N. Wolfe, Esq. Health Care Attorney • MIPS and MACRA: What Healthcare Valuators Need to Know Now – Business Valuation Resources Webinar(November29, 2016). • Strategies for Developing Compliant Physician Compensation Plans - AMGA Compensation Collaborative(November10, 2016) New York, NY. • Physician Compensation Data: Questions and Answers for the Era of Value Based Reimbursement - AHLA Webinar(August 29, 2016). • Innovation Through Alignment: Strategies and Emerging Models for Successful AMC Physician Partnerships: AHLA AMC Conference(March 14-15, 2016) Washington,DC. • Exploring Gainsharing and ACO Compensation Trends - AMGA Annual Meeting (March 10, 2016) Orlando, FL. • Maintaining Compliance While Compensating Physicians for Quality and Cost Savings; HFMA, National Payment InnovationSummit(February 12, 2016) Memphis, TN.
Agenda • • • • • • Part I: Introductory Concepts Part II: Overview of the Regulatory Standards Part III: Value-Based Compensation, Waivers and Gainsharing Models Part IV: Quality Performance Incentives Part V: Developing Best Practices Part V: Question and Answer 3
Health Care Reform Trends • • • • • • • • • • New Payment and Service Delivery Models Population Health Bundled Payments Medicaid Expansion Health Exchanges Accountability and Shared Risk Market Consolidation Gainsharing MACRA, MIPS and APMs Provider-Sponsored Health Plans Access Triple Aim Cost Quality 5
The Road to Compliance • The Current Climate: – More innovative financial arrangements with physicians – More reforms of health care delivery and payment models – More initiatives promoting population health management – Still stuck with a rigid and technical regulatory framework – Enforcement + disproportionate penalties = Astronomical Damages and Enterprise Risk Considerations for Managing Risk: – New models must be defensibleunder the all applicable health care laws – Focus on demonstrating the 3 Tenets of Defensibility: Fair market value (“FMV”), commercial reasonableness (“CR”) and not taking into account (“TIA”) referrals – Documentationand governanceprocesses (e.g., business planning, valuation, etc.) should support defensibility – For gainsharing models, also focus on building in safeguardsto ensure gainsharing models do not incentivize reductions in medically necessary services – For CMS Innovation Models (e.g., ACOs, BPCI, CCJR, etc.) focus on meeting the applicable technical requirements and the fraud and abuse waiver requirements •
Focus on the 3 Tenets of Defensibility • The Toumey Case – FMV – CR – TIA • The Halifax Case – FMV – CR – TIA 7
Recent Cases and Settlements 2014 • • • • • • 2015 • • • • New York Heart Center Infirmary Health System All Children’s Health System Halifax Hospital King’s Daughters Medical Center Memorial Health $1.33 million $24.5 million $7 million $85 million $40.9 million $9.8 million Tuomey Healthcare System Adventist Health System North Broward Hospital District Columbus Regional Health Dr. Andrew Pippas Westchester Medical Center Citizens Medical Center 2016 • Lexington Medical Center • Tenet Healthcare Corp. $72.4 million $115 million $69.5 million $35 million $425 thousand $18.8 million $21.8 million • • $17 million $513 million
