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Hotest New P4P Metric & 7 Resources

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Whether you have an ACO or not, patients’ adherence to treatment is affecting your organization in a meaningful way. While non-adherence to prescribed orders for medication, therapy, diet, and physical activity is driving the largest segment of ACO costs through chronic diseases, for non-ACO organizations many don’t realize that treatment adherence can also be a consideration in patient eligibility for high-dollar surgeries like kidney and heart transplants, as well as gastric lap banding. (more…)

Co-Management Compliance: Audit and Assessment

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The OIG noted in the 12-22 advisory opinion that the hospital requestor uses an independent review firm to annually review the data related to the components of the performance fees, as well as the group’s performance.

Hospitals and health systems are using co-management arrangements with great frequency to align with physicians and achieve operational efficiency and improved patient outcomes.  These arrangements will increase in prevalence and perhaps expand in scope as Medicare’s Hospital Readmission Reduction Program increases payment penalties to 3% and expands to include knee/hip replacements and COPD in 2015.  (more…)

Stark Law and Contract Drafting Perils

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byMatt Fisher 

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In case anyone is unfamiliar with the Stark Law, it is the commonly used name of the Physician Self-Referral Statute.  As a general matter, the Stark Law prohibits a physician (or an immediate family member) from referring patients to an entity for designated health services with which the physician has a financial relationship.  While the Stark Law generally prohibits referrals in certain circumstances, there are many statutory and regulatory exceptions that make an otherwise impermissible relationship allowable. (more…)

Legal Considerations for Buying a Medical Practice

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By: Jeffrey L. Cohen, Esq.

As physicians retire and the era of healthcare reform rocks physicians, opportunities to purchase practices will likely surge, and not just for entities that employ physicians, like hospitals. The big issues generally break down like this: (more…)

7 Ways Physicians Increase Their Income

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7 Ways Physicians Increase Their Income

After working with thousands of rich and poor physician practices all over the United States, trends have emerged among the rich physicians. We’ve observed seven major ways that physicians increase their income. (more…)

6 Pro Forma Mistakes Medical Start-Ups Make

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Going Phishing

Have you ever reviewed an overly optimistic financial projection? Physicians and hospitals frequently rely on subject matter experts to develop new service lines or start-up specialty businesses. Here are 6 areas to vet in pro formas for start-ups. (more…)

Webinar: Co-Management Feasibility & Development

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Co-management has gained mainstream acceptance with the OIG’s favorable 12-22 advisory opinion

Mainstream acceptance of physician co-management has been galvanized by the OIG’s favorable advisory opinion 12-22. However, building consensus among physicians and executives to develop these arrangements is still a hurdle. (more…)

3 Stages for Influencing Change

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It is important to tailor communications at the early, fragile feasibility stage of project development.  Whether you are trying to develop an ambulatory joint venture, co-management arrangement, or other alignment deal, you can advance projects faster by tailoring your communication to each stakeholder’s specific stage of readiness for change. (more…)

Healthcare Businesses Feel More Aggressive

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Church-sponsored hospitals were serving the elderly and poor in the United States over 100 years before Medicare and Medicaid even existed.  Now U.S. healthcare is a $3.0 trillion per year industry.  There are few nun administrators anymore, and we’ve seen some pretty aggressive business behavior.  Here are a few examples. (more…)

Crash Course Video: Payor Contract Analysis

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You really can’t afford to make any mistakes when performing a payor contract analysis. This crash course covers the essentials of reimbursement systems, types of payor contract analyses, and common mistakes. (more…)

Crash Course Video: What is a DCF?

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This brief video crash course will cover when a DCF is used, how it works, and major benefits and shortcomings. (more…)

68 Reasons Co-Management is Replacing Medical Directors

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Pros and cons.

There are 68 quality metrics collectively levied under Medicare’s Hospital Value-Based Purchasing program, Hospital Readmission Reduction Program, and Accountable Care Organization program.  Because there are so many performance metrics affecting hospital and ACO reimbursement, co-management arrangements are emerging as a strong alternative to traditional medical directorships. (more…)

16 Red Flags Detectable During Due Diligence

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Surprise
Surprise!

After doing 600 deals, we have encountered our fair share of surprises.  If you work with enough businesses you are bound to see and hear some odd things.  Here are examples of sixteen (16) very real red flags that could be found during due diligence.  These are things you do not want to miss. (more…)

Presentation: 10 Imaging Center Sales Mistakes

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In this presentation, Ed Field, Director of Imaging Services for Santa Fe Imaging, and Kyle Tormoehlen, ASA, MBA, co-founder of HCT Advisors, discuss the current M&A market for imaging centers and common pitfalls. (more…)

ACO & CIN Webinar: Readmissions & P4P

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Linda Huffer, RN, MBA, COO of CHI National Home Care and Consolidated Health Services

This insightful webinar on hospital readmissions is intended for accountable care organizations, clinically integrated networks, and payors and hospitals participating in pay-for-performance programs.  Linda Huffer, RN, MBA, Chief Operating Officer of CHI National Home Care and Consolidated Health Services, will discuss how her organizations partner with hospitals and battle readmissions. (more…)

14 Doctor Deals that Fight Disease

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Doctor deals are great tools for fighting disease. This list identifies 14 types of business deals between physicians, hospitals, and other organizations that fight disease. They are listed in alphabetical order. (more…)

Patient Incentive Waivers for ACOs

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Patient incentives and accountable care organizations
Patient incentives and accountable care organizations

On November 2, 2011, the U.S. Department of Health and Human Services issued an interim final rule which identified legal waivers allowed for Accountable Care Organizations (ACOs)[1].  HHS specifically identified “patient incentive” among the five types of waivers. (more…)

Primary Care Has 15 Minutes to Save the World

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Primary Care Has 15 Minutes to Save the World
Primary Care Has 15 Minutes to Save the World

According to the MedScape 2014 Physician Compensation Report, 50 percent of primary care physicians spend 16 minutes or less with each patient. This is impressive because primary care physicians are now mostly responsible for treating the largest, most expensive category of diseases in the United States–chronic disease. (more…)

11 Types of Physician Non-Compete Restrictions

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Non-compete restrictions are common features of many types of arrangements between hospitals and physicians. Here are 11 types of physician non-compete restrictions. (more…)

Aligning Providers Under Value-Based Reimbursement

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Value-based reimbursement is forcing different types of providers to collaborate.
Value-based reimbursement is forcing different types of providers to collaborate.

All major commercial payors have deployed value-based reimbursement systems and are preparing to expand their use during the next year.  This creates a compelling need to align primary care physicians, physician specialists, hospitals, pharmacies, and post-acute providers under the new wave of value-based reimbursement systems used by Medicare and commercial payors. (more…)