Paying Healthcare Providers for Quality and Value: Key Trends and Stark Law Considerations

Event Information
Product Format
Prerecorded Event
60 minutes
Product Description

Refine your Value-based Strategy to Improve Quality of Care and Improve Patient Outcomes

Healthcare reform and new payment trends are leading medical groups, payors, hospitals and health systems to consider new compensation models, which will improve their quality and efficiency, help in cost management, and will enhance their capabilities in providing value-based care. Medicare, Medicaid and private payors are looking to accelerate the transition from volume to value and population health through targeted incentives. Going forward, healthcare leaders need to develop a value-based strategy so they can position their organizations for financial success in the new value-based world.

A refined and comprehensive value-based strategy can advance important goals for a healthcare organization, among them: enhancement of quality of care and improvement of patient outcomes; promotion of safe medical practices; sharing of best clinical practices; increased efficiencies in care delivery; facilitation of appropriate utilization of services; and alignment of financial incentives.

Join this session, where expert speaker Joseph Wolfe will provide a better understanding of the legal issues surrounding paying for quality and value so you can refine your current strategy and can identify new delivery models and potential opportunities. Joseph will provide a straight-forward, practical explanation of developing concepts, including the quality and value metrics into new federal healthcare 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 help you position your organization for success in this new value-based world.

Session Highlights

  • A general overview of new quality and value-based payment trends
  • The new quality payment program (QPP) of the Centers for Medicare & Medicaid Services (CMS)
  • QPP pathways and potential options for clinicians as they navigate the program during the 2017 transition year and beyond
  • Potential strategies for incentivizing physicians in connection with the rollout of new value-based programs
  • Application of the existing regulatory framework (e.g., AKS, Stark, CMP, benefíciary inducement, etc.) to new models aimed at incentivizing population health, quality of care and cost control

Session Agenda

  • Introductory concepts
    • Highlights of healthcare reform trends
    • Complying with the current climate and considerations for managing risk
    • Focus on the 3 tenets of defensibility
    • Focus on defensible business planning
  • Overview of the regulatory standards
    • Regulatory framework covering federal healthcare programs, tax exemption issues, antitrust compliance and state law issues
    • Stark's general framework and common exceptions in it
    • The 3 tenets of defensibility
    • Overview of different aspects of Stark group practices
  • Value-based compensation, waivers and gain sharing models
    • How Stark phases 1 and 2 take on value-based compensation
    • Current issues waivers and caution from CMS for battling fraud and abusé waivers
    • What's prohibited by CMS law, associated penalties and managing gainsharing arrangements
  • Introduction to the CMS quality payment program
    • The two trackers, viz. advanced APMs and MIPS
    • Potential adjustments under MIPS
  • Developing a quality and value strategy
    • Considerations for developing a PHM model strategy
    • Quality model compliance considerations

Who Should Attend

  • In-house counsel
  • Healthcare compliance officers
  • Healthcare human resources
  • Healthcare CFOs
  • Healthcare executives

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

Order Below or Call 1-844-384-4744 Today

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About Our Speaker

Joseph Wolfe - Stark Law Expert


Joseph Wolfe is a partner with Hall, Render, Killian, Heath & Lyman, P.C., the largest health care focused law firm in the country, now with offices nationwide. Hall Render's attorneys provide advice and counsel to many of the nation's largest health systems, hospitals and medical groups on a variety of health care issues. Mr. Wolfe regularly counsels clients on a national basis regarding compliance-focused physician compensation strategies. He...   More Info
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