Hospitals Accountable Care Organizations

News & Analysis as of

Federal Trade Commission and Department of Justice Hold Joint Workshop on Payment Models and Competition Within the Health Care...

On February 24-25, 2015, the Federal Trade Commission (“FTC”) and Antitrust Division of the Department of Justice (“DOJ”) co-hosted a second public workshop as part of the “Examining Health Care Competition” series to study...more

FTC and DOJ Host Workshop Examining Health Care Competition - Updated 2015

The Federal Trade Commission (FTC) and the Antitrust Division of the U.S. Department of Justice (DOJ) held a public workshop on February 24–25, 2015, to examine recent trends and developments in health care provider...more

Healthcare Legal News: Volume 5, Number 1

CMS ANNOUNCES NEW RULES THAT MAKE OWNER DOCTORS LIABLE FOR ALL PRACTICE MEDICARE DEBTS - Even after they leave the Practice. CMS announced its final rules on "Medicare Provider Oversight" on December 3, 2014....more

Quality Over Quantity: The Shift from Fee-for-Service to Value-Based Payment Systems

The United States Department for Health and Human Services (“HHS”) recently announced its intention to tie thirty percent of fee-for-service Medicare payments to alternative and value-based payment models by 2016. HHS hopes...more

Time to Freshen Up Your Charity Care Policies: Treasury and IRS Issue Final 501(r) Regulations

Among the many new requirements of the Patient Protection and Affordable Care Act of 2010 (“Affordable Care Act” or “ACA”) are amendments to the Internal Revenue Code (“IRC”) that formalize and impose some uniformity in the...more

Recent Favorable IRS Guidance for Tax-Exempt Bond Financed Facilities

The IRS has released guidance in three areas of interest to entities that benefit from tax-exempt bond financings, particularly hospitals and educational institutions. This guidance creates new rules related to management...more

HHS Payment and Delivery Reform Announcement Sets Priorities for Remainder of Obama Administration

One week prior to the unveiling of the President’s first budget under a completely Republican-controlled Congress, the Department of Health and Human Services (HHS) made its most formal announcement yet on the Obama...more

"Health Care Sector Creates Challenges for Distressed Providers, Opportunities for Others"

In 2014, the health care industry continued to see a high level of M&A activity, with announced transactions approaching $440 billion globally by the end of November. In the United States, consolidation continues to occur in...more

Aggressive New Cms Pre-Payment Review Initiative Threatens Physician Practices And Hospitals

According to a recent report in the American Medical News, The Center for Medicare and Medicaid Services (“CMS”) published plans to increase the number of pre-payment reviews of hospital and physician claims from 1.2 million...more

CMS Invites Comment on Availability of Waivers for ACOs That Particularly Affect Post-Acute Care

Solutions and opportunities may be on the horizon for post-acute providers (“PAPs”) and hospitals participating (or thinking of participating) in ACOs that have reservations about taking on additional downside cost risk...more

Impact of Health Care Reform on Provider Liability

In this presentation: - The Changing Healthcare Landscape - Key Features of an ACO/CIN - ACO Standards and Quality Metrics - Examples of Quality Standards - Impact on Board and Corporate...more

Health Care Reform Implementation Update

The Centers for Medicare and Medicaid Services (CMS) began sending reminders last week that open enrollment begins on November 15; CMS’s Marketplace CEO, Kevin Counihan, said that end-to-end testing of HealthCare.gov was...more

IRS Releases Private Business Use Guidelines for ACO Participants

On Friday, October 24, 2014, the Internal Revenue Service (IRS) released Notice 2014-67, providing guidance regarding the circumstances under which participation by a hospital in an Accountable Care Organization (ACO) will...more

The Evolution of Efficiencies and Treatment of Quality of Care Defenses in Light of Changing Health Care Industry Dynamics

The consolidation of health care markets and the impact of this consolidation on prices, costs, and quality, has been a hotly debated topic in the health care industry. Hospitals across the country are merging and acquiring...more

The Reformed Health Care Industry: Creative Structures and Alliances Can Yield Great Benefits, but Also Great Risks

Since the Affordable Care Act (the “ACA”) was enacted in 2010, the health care industry has been on the edge of its proverbial seat waiting to see which care delivery models are best suited to sustain all the changes: to...more

Health Headlines: Also in the News - June 2014 #3

MedPAC Recommends Short- and Long-Term ACO Changes – In a comment letter sent to CMS Administrator Marilyn Tavenner on June 16, 2014, the Medicare Payment Advisory Commission (MedPAC) outlined certain challenges associated...more

A “virtual merger” is underway between Chicago-area Alexian Brothers Health System and Adventist Midwest Health

Chicago-area Alexian Brothers Health System and Adventist Midwest Health signed a non-binding letter of intent to form a joint operating company, a collaboration commonly referred to as a virtual merger. As Alexian brings...more

Health Care in 2014: A Brave New World

With the completion of the enrollment phase of the Affordable Care Act (ACA), health care in the United States has entered a new era that will be characterized by extensive changes and challenges for both providers and...more

American Hospital Association Recommends Revisions to Medicare ACO Models

The American Hospital Association (AHA) submitted a letter to the Centers for Medicare and Medicaid Services (CMS) on April 17, 2014, recommending modifications to the Medicare Shared Savings Program (MSSP) and the Pioneer...more

Tax Developments Affecting Health Care Organizations and Investor-Owned Hospital Companies [Video]

Several Treasury regulations, revenue procedures, and other developments have recently been released, which may have important consequences for businesses, including health care organizations. Moreover, changes in regulatory...more

The Current Intersection of Antitrust and Managed Care

This article provides a summary of key healthcare antitrust developments in 2013, highlighted by two important Supreme Court decisions: - In FTC v. Phoebe Putney Health System, Inc.,133 S.Ct. 1003 (2013), the Court...more

CMS Outpatient and Physician Payment Rules: Don't Miss the Efficient Quality of Care Reform Forest for the Dollar Trees

The final physician fee schedule (PFS) and hospital outpatient department payment rules for FY 2014 clearly signal the continued intent by the Centers for Medicare and Medicaid Services (CMS) to transform the healthcare...more

First Year Analysis – The Pioneer ACO Program Wins Some, Loses Some

This week, CMS announced the shared savings results and the clinical achievements from the first year of the Pioneer ACO Program. During the first year...more

OIG ?'s Co-Management Arrangement for Cardiac Cath Labs

On January 7, 2013, the Department of Health and Human Services Office of Inspector General (“OIG”) posted a favorable advisory opinion concerning an existing co-management arrangement (“Arrangement”) between a large, rural,...more

Birmingham Medical News: 2012 Health Care Year In Preview

The health care events of 2012 can be properly divided into "Before" and "After": Before the Supreme Court ruling on the Affordable Care Act and President Obama's re-election and After. Before these two events, the viability...more

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