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Top Takeaways | 2023 PPM-ASC Symposium | ASC 2.0 Selected Trends: Bundled Payments, Tech & Anesthesia

by McDermott Will & Emery | Nov 7, 2023 | Digital Health, PPM/ASC

In this session, panelists discussed recent technological, payment and regulatory trends in the ambulatory surgery center (ASC) space, with a focus on implementing and managing bundled payments. The group also explored complex questions raised on structuring and risk, leveraging technology to streamline ASC operations and maximize business outcomes, and structuring anesthesia arrangements for ASCs.

Session panelists included:

Jason Scalise, MD, Chief Growth Officer, HOPCo
Piper Su, Chief Growth Officer, triValence
Tony Maida, Partner, McDermott Will & Emery
Moderator: Ryan Higgins, Partner, McDermott Will & Emery

Top takeaways included:

Bundled Payments

There has been growing interest in expanding the time frame or scope of services included in a bundled payment. Such a shift in focus could help align behaviors and manage the appropriateness of care. But without appropriate real-time data, there are significant challenges in determining the scope and pricing of a bundle.
As the scope of clinical services provided safely in an ASC has continued to expand, there has been a shift from inpatient to outpatient procedures, and driving them to ASCs. The ASC community can play an integral role in determining scope and pricing of bundles.
Bundled payments have had a somewhat spotty reputation in terms of success. One challenge is that the payor may adjust the target annually, leading to cost-cutting and a race to the bottom until there is no opportunity for additional savings. Going forward, bundled payment programs should be developed with an eye toward sustainability, building in inflationary trends, demographic shifts and [...]

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Top Takeaways | 2023 PPM-ASC Symposium | Specialty Spotlight: Behavioral Health

by McDermott Will & Emery | Oct 31, 2023 | PPM/ASC

In this session, panelists provided an in-depth look at focus and sub-focus areas within the behavioral health industry. Our panel also discussed supply and demand imbalances, merger and acquisition (M&A) transaction considerations, reimbursement trends, digital and telehealth services, and other issues companies within the behavioral health market should consider.

Session panelists included:

Gaurav Bhattacharyya, Founder and Chief Executive Officer, Geode Health
L.A. Galyon IV, Managing Partner, Brentwood Capital Advisors
J.R. Green, Chief Executive Officer, Psychiatric Medical Care
Rita Ratner, Managing Director, Farragut Square Group
Jake Stark, Vice President, WindRose Health Investors
Moderator: Marshall Jackson, Partner, McDermott Will & Emery

Top takeaways included:

Supply and demand imbalances have been exacerbated, as there is an increase in mental disorders and care models are trying to meet the needs.
The industry is seeing an increase in integration of mental and physical health.
Companies have been focusing on preventive outpatient care to help reconcile staffing imbalances, as well as using a mix of psychiatrists and various mid-level providers.
Clinical reputation and clinical alignments are two major factors investors examine when evaluating practices to acquire.
Payors are expanding reimbursement for various behavioral health services; however, behavioral health is not ready for value-based care—a key issue being the difficult-to-measure outcomes across behavioral health services.
Digital health is a key focus area in behavioral health; however, the effectiveness of digital health tools is predicated on the types of services being provided and the adoption of these tools by patients, consumers and providers. Many behavioral [...]

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PPM ASC Symposium 2023 | Trends in Value-Based Care Models

by McDermott Will & Emery | Oct 17, 2023 | PPM/ASC

In this session, McDermott Will & Emery Partner Matthew Perreault moderated a panel that collected insights on how the value-based care market has shifted, how investors and other stakeholders can partner on value-based care initiatives, and the different challenges that primary and specialty care providers are facing today.

Session panelists included:

Rick Goddard, Vice President, Commercialization & Strategy, Lumeris
Matthew Perreault, Partner, McDermott Will & Emery
Scott Rosen, Partner, Transformation Capital
Robin Shah, Founder and Chief Executive Officer, Thyme Care
Kyle Wailes, Chief Executive Officer, Wellvana

Top takeaways included:

Investment and interest in value-based care has never been stronger. Historically, many stakeholders have thought about value-based care defensively. Today, there are opportunities to engage in value-based care more offensively. There are different approaches to take in entering the market, and more partners and intermediaries to collaborate with than ever before.
Value-based care is not a one-size-fits-all model. Stakeholders should be deliberate in their approach and consider the right geographies, lines of business, and partners for growing their businesses. This could involve acquiring a primary care practice directly, partnering with a payor to identify a market for growth, building high-performing and/or affiliate networks, and more.
Those looking to invest in value-based care should consider factors such as the following: whether the model produces better clinical outcomes and cost savings; how to engage patients; whether the model is scalable from one geography to the next; how to contract with payors who typically have better data; what tools will generate [...]

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Top Takeaways | PPM, ASC and Health System Collaborations and Innovation

by McDermott Will & Emery | Oct 3, 2023 | PPM/ASC

In this moderated session, panelists discuss how physician practice management companies (PPMs), ambulatory surgery centers (ASCs) and health systems are both competing and collaborating in the evolving healthcare environment.

Session panelists included:

Lexa Heinz, Vice President, Iron Path Capital
Chris Kehres, Chief Growth Officer, executive vice president of finance, GI Alliance
Andy McCawley, Chief Development Officer, United Surgery Partners International
Gary Ruff, Vice President, Ambulatory Surgery Centers, CHRISTUS Health
Moderator: Jay Greathouse, Partner, McDermott Will & Emery

Top takeaways included:

Physicians are looking for three key items: (1) partnerships with ASC operators or health systems that can bring higher and/or better rates, (2) assistance with recruitment that ensures older physicians will get their buyout at retirement and younger physicians are not saddled with operations or debt of a center, and (3) management responsibility for ensuring that centers are operating efficiently.
Since the COVID-19 pandemic, health system partners are being more proactive versus reactive to volume leaving a hospital setting. For example, more health system partners are willing to have employed physicians invest in its surgery centers and are using it as a recruitment and retention tool for employed physicians.
Physician consolidation is helpful because it creates more value in the form of higher rates or ancillaries, which are income drivers, and assists with recruitment. Physician consolidation also is helpful in expanding geographic footprints, as a larger practice may be present in multiple markets.
Certificate of need (CON) requirements are a big challenge to bringing health systems into [...]

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Top Takeaways | Specialty Spotlight: Gastroenterology

by McDermott Will & Emery | Sep 19, 2023 | PPM/ASC

In this moderated session featuring perspectives from top gastroenterology (GI) executives, panelists explored the thriving state of marketing and dealmaking in this field.

Session panelists included:

Robbie Allen, Chief Executive Officer, One GI
Matt Devine, Chief Executive Officer, Allied Digestive Health
Michael Kroin, Chief Executive Officer and managing partner, Physician Growth Partners
Samuel Vaill, Chief Development Officer, United Digestive
Moderator: Amanda Jester, Partner, McDermott Will & Emery

Top takeaways included:

Gastroenterology continues to be an attractive specialty for investment. This is due to a number of factors, including gastroenterology’s diverse revenue streams that can provide income repair for physicians and generate alignment among stakeholders. The increased push for outpatient surgical care to lower costs of care and the decreasing age of patients seeking colonoscopies and other gastroenterology procedures provide investors with significant runways to drive growth.
As labor costs increase and challenges in the healthcare industry continue, physician practice management organizations provide gastroenterology groups with economies of scale, the ability to develop ancillaries and strong recruiting programs, as well as leverage against disruption by payors, hospital systems and competitors. Other advantages include access to expansive clinical data for research and development and improved point-of-care support.
Culture is an oft-overlooked factor in gastroenterology transactions. Because transactions are intended to foster long-term arrangements, ensuring cultural alignment is key for the future success of a platform. Physicians should also consider the ways in which the platform focuses on the physician and the support of their practice as well as the [...]

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Top Takeaways | 2023 Physician Practice Management & ASC Symposium 2023 | Fraud & Abuse Risk Mitigation and Enforcement Trends

by McDermott Will & Emery | Sep 5, 2023 | PPM/ASC

In this session, McDermott Will & Emery Partners Denise Burke, Tony Maida and Monica Wallace discussed top issues and enforcement trends that physician practice management companies (PPMs) and ambulatory surgery centers (ASCs) should watch to mitigate their fraud and abuse risk. The panel also discussed the potential impact of recent regulatory changes on future enforcement priorities.

Session panelists included:

Denise Burke, Partner, McDermott Will & Emery
Tony Maida, Partner, McDermott Will & Emery
Monica Wallace, Partner, McDermott Will & Emery

Top takeaways included:

The federal government recently released False Claims Act recovery data for 2022. While the recovery amounts went down, the number of reported cases actually went up. We anticipate seeing more COVID-19-related enforcement actions. We are also seeing continued government focus on financial arrangements with physicians, including transactions involving physicians receiving preferential investment terms, such as below-fair-market-value purchase prices.
In the most recent revision to the Stark rules, there is a new ability to cure compensation errors. Specifically, if a designated health services (DHS) entity has a compliant written compensation arrangement with a physician and discovers a payment error during the term of the arrangement or within 90 days of termination, the entity can correct or reconcile the compensation error and there is no need to submit a self-disclosure. The US Centers for Medicare & Medicaid Services (CMS) recently said that errors could even be fixed after 90 days from termination, but this requires a close analysis of the facts.
The federal government has started [...]

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Top Takeaways | 2023 Physician Practice Management & ASC Symposium | Maximizing Managed Practice Value & Operations

by McDermott Will & Emery | Aug 22, 2023 | PPM/ASC

In this moderated session, a panel of senior executives and stakeholders with significant experience in optimizing physician practice management valuations discussed how managed practices can add substantial value by improving the efficiency of revenue cycle performance, implementing innovative managed care strategies and developing ancillary service lines.

Session panelists included:

Roy Bejarano, Co-Founder and Chief Executive Officer, SCALE Healthcare
Katy Dettman, Managing Director, Ankura
Danielle Duke, Chief Operating Officer, MSO, Unified Women’s Healthcare
Moderator: Larry C. Guess, Partner, McDermott Will & Emery

Top takeaways included:

Healthcare management organizations can assist physician practices in improving their revenue cycle performance by implementing automated billing systems and using data analytics to identify potential billing errors.
One strategy for addressing the labor shortage in healthcare is to look beyond traditional physician roles. By allowing physicians to operate at the top of their license, organizations can ensure that physicians are maximizing their expertise and using their skills to the fullest extent. Additionally, hiring advanced practice providers can help fill gaps in care and improve access to services.
Other recruitment and retention strategies include building relationships with medical residents earlier in their training to create a pipeline of physicians. Organizations can offer training programs and incentives that encourage residents to stay within the organization or community after completing their training. In addition, clinical governance models that empower physician shareholder decision-making creates a sense of loyalty and stickiness that can help retain talent.
Healthcare organizations may add more value by focusing on internal marketing measures, [...]

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Top Takeaways | Specialty Spotlight: Orthopedics/Physical Therapy

by McDermott Will & Emery | Aug 8, 2023 | PPM/ASC

In this session, Patrick Zanayad, a partner in McDermott’s Healthcare practice group, moderated a panel of senior healthcare executives that featured a wide-ranging discussion of the current state of orthopedics and physical therapy (PT) and explored what’s coming next in this important specialty.

Session panelists included:

Charles Davis, Managing Partner, MD Healthcare Partners
Thomas Dwyer, MD, President, Premier Orthopaedic Associates (part of American Orthopedic Partners)
Emil Engels, MD, Chief Executive Officer, Aligned Orthopedic Partners
Keith Lockwood, ManagingDirector, Jefferies & Company

Top takeaways included:

Income repair in orthopedic platforms can be achieved through multiple avenues, including, among others, by fostering ancillary growth, introducing surgery-center ownership, negotiating better managed-care contracts, entering unique partnerships with entities and participating in integrated networks.
As value-based care (VBC) continues to grow in the healthcare industry, orthopedic platforms with capital support are better positioned than smaller, independent practices to participate in VBC due to the larger entities’ greater access to quality patient data, particularly given the costs associated with gathering such data. Further, orthopedics, unlike other specialties, has an advantage in VBC models since such practices tend to have more control over a patient’s full care journey and costs. For example, certain orthopedic platforms include practices with urgent-care centers that promote the practice’s ability to capture a patient’s entire spectrum of care, including surgical procedures and post-op physical therapy.
Orthopedic platforms can promote vertical growth through a number of pathways, including, among others, by adding new physicians and developing ancillary streams of revenue such [...]

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Reforms to the Florida Patient Self-Referral Act: A Closer Look at the Impact of SB 768

by Jamie Gelfman and Lester Perling | Jul 28, 2023 | Hospitals & Health Systems, PPM/ASC

Florida Senate Bill 768 (SB 768) amends the Florida Patient Self-Referral Act of 1992 (PSRA), which regulates referrals from healthcare providers, including physicians, to entities in which they have ownership and other investment interests. This amendment, which became effective July 1, 2023, has important implications for Florida physicians subject to the PSRA by making the physician supervision requirements less onerous. Although this change offers potential benefits, Florida physicians, including those who do not currently participate in the Medicare program but are subject to the PSRA, must ensure they understand and implement the revised supervision requirements, which are identical to Medicare’s supervision requirements.

Read the full On the Subject.

Top Takeaways | 2023 PPM-ASC Symposium | Leveraging Data Collaborations for Revenue Growth

by McDermott Will & Emery | Jul 25, 2023 | PPM/ASC

In this session, the panelists discussed the successes and challenges of a data collaboration between Gastro Health and Lynx.MD, and provided real-world insights into how a physician platform can harness its data to enhance patient care and generate additional revenue while maintaining compliance with applicable privacy and security regulations.

Session panelists included:

Omer Dror, Founder and Chief Executive Officer, Lynx.MD
Rich Weissmark, Senior Vice President of Strategic Operations, Gastro Health
Moderator: Stephen Bernstein, Partner, McDermott Will & Emery

Top takeaways included:

Organizing and understanding patient data can require a large up-front investment, as it can be costly, time-consuming and challenging. This is often the largest hurdle in data collaborations; but once that step is addressed, the ability to harness the data for patient care and research can be exponentially valuable over time.
Data has a multitude of uses, e.g., internally within a practice to improve patient care and externally with life sciences partners and other stakeholders to analyze trends and forge innovation (provided that data shared externally is properly deidentified, or takes the form of a limited data set that is subject to proper data-use agreements). A physician practice with curated data that can be meaningfully used will be far better positioned to discuss and negotiate value-based care and alternative payment models with various payors.
While some data modeling focuses on just one use, the best opportunities may come from innovations that consider all of the other potential uses for the data. The specific disease states that [...]

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