Reimbursement Archives - HEALTH & LIFE SCIENCES NEWS

Reimbursement

PPM ASC Symposium 2023 | Washington Outlook: Evolving Federal Policy Impacting Reimbursement, Operations and Deal Strategies

by McDermott Will & Emery | Jun 12, 2023 | PPM/ASC

In this session, panelists discussed the political shifts in Washington that are impacting healthcare reimbursement, operations, and deal strategies, including Centers for Medicare & Medicaid Services (CMS) policies on reimbursement, recent activity regarding non-competes and consolidation, and the end of the COVID-19 public health emergency (PHE).

Session panelists included:

Brian Fortune, President, Farragut Square Group
Deborah Godes, Vice President, McDermott+Consulting
Katharine O’Connor, Partner, McDermott Will & Emery
William Prentice, Chief Executive Officer, Ambulatory Surgery Center Association
Moderator: Eric Zimmerman, Principal, McDermott+Consulting, and Partner, McDermott Will & Emery

Top takeaways included:

Eight years after the passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), CMS continues to make adjustments to calibrate physician reimbursement. As they do so, budget neutrality requirements continue to hamper progress. Providers may have to look to the US Congress to get involved and implement an inflation adjustment factor to the fee schedule.
Ambulatory Surgery Centers (ASCs) may face challenges in obtaining favorable reimbursement as they enter the fifth year of a pilot program in which they have been receiving the same inflation adjustments as hospitals. At the end of the pilot program, it is unclear whether ASC reimbursement will continue to receive the hospital market basket adjustments or go back to Consumer Price Index (CPI) adjustments, which have historically been less favorable than hospital inflation adjustments.
Site neutrality continues to be a hot topic as CMS and Congress looks for ways to minimize incentives to refer patients to one setting over [...]

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Investing in Global Healthcare

by Dale Van Demark, Michael Ryan, Stephen W. Bernstein, Kristian A. Werling, Hamid Yunis, Sharon Lamb, Emmanuelle Trombe and Dr. Stephan Rau | Jun 10, 2021 | Digital Health, Health M&A, Health Private Equity, Life Sciences

Today’s global healthcare marketplace is marked by unprecedented transformation. This presents both challenges and opportunity to today’s market participants. We know how important it is to structure cross-border investments and transactions to account for complex and ever-shifting regulations.

Within this dynamic environment, our health lawyers wield a deep knowledge of how healthcare services, medical technology and pharmaceuticals are delivered around the world, and how the laws that affect those entities and that help drive action are creating the market of tomorrow.

Bringing this experience and commercial focus together we are proud to present the Global Guide to Investing in Healthcare. Our one-stop resource is here to guide you through the healthcare systems of key jurisdictions, helping you to explore the regulation and provision of healthcare services, merger and foreign investment control, anticipated changes in healthcare and life sciences law, and much more.

Click here to visit our interactive report, and start exploring the opportunities and challenges for your business today.

Policy Outlook: How The 2020 Election Outcomes Will Impact Your Business – Health Policy

by McDermott Will & Emery | Nov 6, 2020 | Health M&A, Health Private Equity, Hospital Health Benefits

In this session, health law policy authorities discussed changes likely in 2021 in a Biden Administration and how these changes will impact business objectives and strategies for health industry stakeholders.

Below are the top takeaways for Policy Outlook: How The 2020 Election Outcomes Will Impact Your Business session: Health, click here to access the full webinar.

Access the PDF here

COVID-19
If Vice President Biden campaigned on anything, it was a more vigorous response to the pandemic. Look for a Biden Administration to make addressing the spread and restoring the economy top priorities early on. Another relief bill is likely, and maybe even in a lame duck session in 2020, but any relief measure will require Republican and Democratic support. Look at both the House-passed HEROES Act and the Senate Republican HEALS Act as likely starting points for discussion.

Affordable Care Act
Vice President Biden campaigned on sustaining and expanding health insurance coverage by enacting a public option to compete with commercial plans in exchange marketplaces. With Republicans likely to retain control of the Senate, legislative expansions of the ACA are unlikely. Instead, look to a Biden Administration to reverse or revise ACA-related regulations and Executive Orders advanced by the Trump Administration. Still, keep an eye on the Supreme Court’s consideration of California v. Texas, which could call the constitutionality of the ACA into question.

Prescription Drug Pricing
Both parties share the goal of addressing the cost of prescription drugs, and there [...]

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5 Questions with a Health Policy Specialist: Rodney L. Whitlock of McDermott+Consulting

by McDermott Will & Emery | Aug 20, 2020 | Uncategorized

Rodney L. Whitlock, Ph.D
Vice President, McDermott+Consulting
Focus Area: Healthcare Policy
Years at M+: 1.5 years

What is your favorite part about your health policy work at McDermott+Consulting?

Healthcare policy, politics and process is complicated. It is a constant challenge to discern and anticipate the future of healthcare policy for clients. It is the constant intellectual challenge of operating in healthcare policy that I enjoy most about what I do. Specifically, I like that I can bring my 21 years of experience in Congress to my clients, move from subject matter to subject matter and play at a high level. For example, I can go from talking about prescription drugs in the morning then later on in the day dealing with an issue very specific to a client. It’s the challenge of having to be in different spaces at different times of the day that I actually enjoy.

What is the biggest opportunity and greatest challenge facing clients in your area of focus today?

The current global pandemic has significantly impacted healthcare. All of the pressures on pricing and value that existed before the pandemic are now accentuated by the response to the crisis. The recovery from the loss of revenue experienced by providers throughout the year 2020 will be felt for a long time to come. The way practices have changed to accommodate the pandemic will also impact the provision of healthcare services and how they are reimbursed for a long time [...]

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Five Questions with a Health Lawyer: Drew Elizabeth McCormick

by McDermott Will & Emery | Jul 30, 2019 | Uncategorized

Drew Elizabeth McCormick
Associate
Office: Boston
Years at Firm: 2

What is your favorite part about practicing health care law at McDermott?

I get to work with world class lawyers on cutting edge issues and help our clients navigate the challenges of succeeding in a very dynamic, heavily regulated industry. I am constantly being challenged and learning new things, all while having the honor of helping guide our clients in transforming health care.

What is the biggest opportunity and greatest challenge facing clients in your area of focus today?

Definitely the ability to take on risk and succeed in a value-based payment paradigm. We are seeing many shifts in the industry, which are largely being driven by fundamental changes in reimbursement structures away from fee for service. Compounding this, the regulatory framework is lagging behind in many regards, creating tensions and uncertainty that our clients lean on us to help them resolve.

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Five Questions with a Health Lawyer: Karen Owen Gibbs

by McDermott Will & Emery | Feb 28, 2019 | Reimbursement

Karen Owen Gibbs
Partner, McDermott Will & Emery
Office: Chicago
Years at the Firm: 5

What is your favorite part of practicing health care law?

US health care law is interesting, fast-changing and relevant to virtually every person in the United States. As the health care space changes to incorporate new technologies and adjusts to meet patient expectations, I work with my clients on a range of issues that were not on the radar 10 or even five years ago. For example, I do a lot of work in the pharmaceutical industry, including facilitating collaborations between traditional pharma companies and new players, helping clients address reimbursement challenges resulting from the transition to value-based care, and helping providers navigate the opioid crisis. It’s an exciting time to help clients bring new and better care to patients.

What is the biggest opportunity and the greatest challenge facing clients in your area of focus today?

The challenge and the opportunity are closely related. Many clients are seeking to maximize opportunities within today’s rapidly evolving regulatory and reimbursement climate. Current health care policy is highly focused on delivering better care to more people at a lower cost. Our clients are looking for opportunities to deliver on that challenge. That can include collaborating with partners from outside the health care industry such as [...]

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Three Environmental Factors Impacting the PPM Industry and Getting Deals Done

by Jerry J. Sokol | Jul 10, 2018 | Health Antitrust, Health M&A, Health Private Equity, PPM/ASC, Reimbursement

The PPM industry is by no means immune to the ebbs and flows of a traditional marketplace. Since the consolidation bubble burst in the 1990s, PPMs have gone from practically extinct to a once-again substantial component of the health care delivery system. But with greater influence comes more pressure to respond, and adapting to today’s complex operating environment requires those in the PPM industry to ensure they are building the foundational structure needed to help practices adapt to external factors and achieve long-term success.

Here are three defining aspects of today’s complex PPM environment, as well as several important considerations to help navigate environmental uncertainties and create a better patient experience.

Physician satisfaction and expectations are changing: As millennial doctors enter the workforce, they’re driving a sea change in terms of job expectations. With better work-life balance as a top priority, many young physicians are looking to be employees rather than employers, joining an existing practice instead of starting their own. Therefore, communicating what a PPM has to offer in terms of long-term incentives, rather than short-term profit margins, will be crucial to drawing in younger doctors and building a foundation that will last into the future.
Reimbursement strategies are evolving: Payer models and expectations continue to shift. Patients are being folded into a system that’s evolving from fee-for-service to value-based reimbursement models. As of now, the federal government is the biggest source of health care reimbursements in the country, but how legislative changes to reimbursement frameworks will impact [...]

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