New Opportunities for Value-Based Care with HHS Finalization of Stark Law, Anti-Kickback Statute, and Civil Monetary Penalties Law Reforms

The Department of Health and Human Services (“HHS”), in collaboration with the Centers for Medicare & Medicaid Services (“CMS”) and the Office of the Inspector General (“OIG”), has issued two final rules clarifying certain regulatory terms and adding and amending exceptions and safe harbors to accommodate “value” transactions under the Anti-Kickback Statute (“AKS”), the federal Physician Self-Referral Law (the “Stark Law”), and the Civil Monetary Penalties Law (the “CMP Law”). The following is a summary of the new rules, followed by certain examples of potential real-life applications of the changes.

Health Care’s Retail Revolution

Consumer expectations for convenience and personalized service have shaped many industries. But even a decade ago, health care wasn’t one of them. “The notion of a consumer experience in health care—that seemed like such a foreign concept years ago,” says Barry Uphoff, managing partner and founder of Martis Capital, a private equity firm that invests in middle-market health care companies. That’s changed. Today, the patient experience is shaping the way care is delivered, and it’s prompting health care providers to rethink their offerings and how they measure business performance.

COVID-19 Financial Impact on Physician Practices

The economic impact of COVID-19 on health care continues to reveal itself through reductions in patient volume and revenue and in higher practice costs. As the pandemic stretches on, physician practice viability remains under threat. Financial impacts were assessed with a claims-based analysis of changes in Medicare physician spending for the first six months of 2020 and a nationwide survey of physicians in July and August of 2020.

The Most Promising Innovations in Healthcare

Scientific advances can speed effective responses to future pandemics and health crises. Ten promising innovations are on their way. But effective prevention or cure is limited for some diseases, and societies and economies remain at risk to unpredictable health crises. Innovative technologies can help address pandemics in at least four areas, but today’s innovations go beyond viral outbreaks to address cancer, diabetes, heart disease, aging, and other health conditions.

4 Healthcare Antitrust Issues to Watch

The past year has been ripe with antitrust activity in the health sector, with ripple effects likely to spill into the near future and beyond. The Federal Trade Commission is poised to get even more aggressive in enforcement against anticompetitive deals in the years to come, legal experts told Healthcare Dive, while state legislatures are eyeing ways to increase scrutiny of mergers and acquisitions in their own backyards. The FTC said last year it was expanding a program that helps it police future and already-consummated deals. And just last year the agency made its first challenge to a hospital tie-up after a three-year lull.

ICYMI: Top Deals & Developments, Week of 2/22-2/26/21

Sage Dental’s practice acquisitions head the list of the top deals and developments from last week’s set of Daily Notes, with other notable updates including ATI Physical Therapy’s SPAC deal and the potential future for Audax’s Gastro Health.

The Emerging Landscape in the Next 24 Months: What the Industry’s Pioneers Think Might Happen

What might happen in the next 24 months, in the healthcare system? Healthcare Innovation asked several senior executives of pioneering provider organizations—and they had some ideas.

Forecasting Healthcare Regulatory Developments in a Biden Administration

President Joe Biden was sworn into office on January 20, 2021. As with any incoming administration, new policies will be pursued while those of the previous administration are furthered, abandoned, or undone. The federal government is an enormous bureaucracy with several layers and, therefore, converting policies into quantifiable results takes months or even years. Early indicators of policies’ prioritization, implementation, or their likelihood of success can provide a head start to regulated businesses scanning the horizon. It is in that spirit that Wilson Sonsini offers the following insights to forecast how the Biden administration will shape the healthcare ecosystem for the years to come.

2021 Health Report

In this report McDermott Will & Emery has assembled a comprehensive overview of the healthcare industry in 2020, with particular emphasis on the legal implications of the unprecedented year. McDermott also looks ahead to the future of the industry, which is full of opportunities to break down long-standing barriers to innovation and move towards a more modern and patient-centric vision of care in many areas.

Value-Based Care in 2021: 5 Emerging Trends in Value-Based Care

The pace and pressure to embrace value-based care are picking up. The COVID-19 pandemic exposed the risks and limitations of reliance on fee-for-service reimbursement and, combined with the groundbreaking changes in health care delivery models and regulatory flexibility, indicate a renewed focus on value-based care. This article outlines five of the top trends to watch for in value-based care for 2021.