Accountable Care Organizations & Physician Hospital Alignment Strategies

Our Approach

The Patient Protection and Affordable Care Act is forcing health care providers to reexamine their existing operating models and explore alignment strategies for long-term viability in the market.

We’re at the forefront of Accountable Care Organization (ACO) implementation and have working knowledge of ACO formation and operation, including the Medicare Shared Savings Program and the Pioneer and Advance Payment models.

We enjoy strong relationships and open communication with regulators at the Centers for Medicare & Medicaid Services / Office of Inspector General, the CMS Innovation Center and the Federal Trade Commission. This helps to clarify ambiguities and validate our interpretations of the law, ensuring compliance with payment policies, physician self-referral and anti-kickback safe harbors, Stark exceptions, antitrust, privacy, security and Civil Monetary Penalty (CMP) laws.

We offer strategic counsel on forming and operating Independent Practice Associations, Physician/Hospital Organizations, Management Service Organizations, provider networks and ACOs, routinely advising on licensure, practice management, fraud and abuse, valuation methodologies and reports and nonprofit tax issues.

Working closely with the health network’s professional staff and consulting organizations, we also support the design and implementation of clinical integration initiatives, including drafting and negotiating ACO network agreements and agreements between ACOs and IT vendors.

We work with

• Accountable Care Organizations
• Hospitals and health systems
• Independent practice associations
• Managed care organizations
• Physician/hospital organizations
• Provider networks