Offering alternative value-based payment options to payers differentiated you and delivered competitive advantages. Now, if you don't, you'll be left out. Are you ready to risk that?...
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Problematic Arrangements Between U.S. Hospitals and Their Staff Physicians
By MARIA TODD Sublease Agreements: Hospitals cannot enter into sublease arrangements with physicians in order to host town hall meetings with Medicare, Medicaid, or otherwise insured beneficiaries in the physicians’ offices. The rental value for these arrangements must be at fair market value and cannot take into consideration the potential volume or value of...
Continue readingData Blocking and its Effect on Physician Integration and Alignment
CMS Administrator Seema Verma has warned that data blocking will not be tolerated. Healthcare data can be exchanged, but software and applications providers have been accused of hoarding it because for many, their business model has been designed on deriving profits from data hoarding. But if Seema Verma’s admonitions are any indication, them days...
Continue readingWhat’s the difference between “best efforts” and “reasonable commercial efforts”?
This morning, as I was contemplating what to write about for today’s article, I received an email from a client who red lined an offer from a health plan for the new Medicaid Managed Care initiative in Illinois. It seems the payer did not want to accept...
Continue readingVertical Integration Returns to U.S. Healthcare: What You Need to Know Now
In the 1990s, during the Clinton Administration, the USA saw many attempts to achieve vertical integration in healthcare. Here we are again! New acronyms were initiated and made popular to describe Independent Practice Associations (IPAs), Physician Hospital Organizations (PHOs), which were managed and administered by entities known as Management Services Organizations (MSOs). Physicians felt the...
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