Exploring Critical Business and Legal Issues across the Healthcare and Life Sciences Industries
Exploring Critical Business and Legal Issues across the Healthcare and Life Sciences Industries
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PPM ASC Symposium 2023 | Washington Outlook: Evolving Federal Policy Impacting Reimbursement, Operations and Deal Strategies

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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5 Questions with a Life Sciences Lawyer: Doug Carsten

Doug H. Carsten
Practice Focus Area: Patient Litigation
Office: Orange County
Years at Firm: Joined in March 2021

What is your favorite part about practicing life sciences law at McDermott?
I love working with the incredibly talented partners and associates in McDermott Will & Emery’s life sciences group. The level of disparate practice group talent here is remarkable, and I am so excited to collaborate with this team to help our fantastic life sciences clients.

What is the biggest opportunity and greatest challenge facing clients in your area of focus today?
Biggest opportunity: To work with our life sciences team!
Seriously, the biggest opportunity and challenge facing our life sciences clients are the same – the current pandemic landscape. As an opportunity, life sciences companies have never before been so much in the spotlight and viewed as a potential answer to the COVID-19 virus. On the other hand, the very nature of the pandemic has deeply affected and really changed how life sciences – and all companies – conduct business.

What kind of client work gets you most excited when it comes across your desk?
My true love is trying cases. It doesn’t matter what the issue is – if there is a trial involved, I am excited. Secondarily, I really enjoy unpacking complex fact patterns and developing strategies that the client hadn’t thought of to get around particular challenges.

What [...]

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Investing in Global Healthcare

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.

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5 Questions with a Health Lawyer: Sandra M. DiVarco

Sandra M. DiVarco
Practice Focus Area: Health
Office: Chicago
Years at Firm: 19 years

What is your favorite part about practicing healthcare law at McDermott?
I sometimes joke that there is “never a dull moment” in my practice, but it really isn’t a joke! With the spectrum of clients we serve in the healthcare space, we are faced daily with novel questions, complex situations and unique business issues – often with incredibly short timelines. Even after years of practice, no two days are exactly the same and I would not have it any other way.

What is the biggest opportunity and greatest challenge facing clients in your area of focus today?
My practice is primarily focused on assisting hospitals and healthcare systems with the diversity of regulatory and corporate issues they face every day. Even before the COVID-19 pandemic, adapting to the changing nature of healthcare was posing challenges for these providers. The pandemic accelerated the use of what were previously novel care delivery processes, fueled by regulatory flexibilities permitted during the public health emergency. How hospitals and health systems will further adapt by scaling back (in cases where flexibilities are not made permanent) or ramping up (where regulatory changes are made permanent) will be the next challenge. Revenue hits from the pandemic and provider burnout may dampen some of the energy for major change as we emerge from [...]

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5 Questions with a Health Lawyer: Gregory E. Fosheim

Gregory Fosheim, JD, MPH
Practice Focus Area: Healthcare and Life Sciences
Office: Chicago, IL
Time at Firm: 2.5 years

What is your favorite part about practicing healthcare and/or life sciences law at McDermott?
There’s a reason why everyone answers this question with “the people.” The cadre of attorney and business professionals I have the privilege of working with every day is truly extraordinary, each of whom is exceedingly generous with their time and support, despite overwhelming workloads themselves. Everyone understands the healthcare and life sciences landscape and has an unapologetic passion toward doing impeccable work with the utmost professionalism and a healthy dose of humor and humility. It felt like I was given a parachute on my first day that allowed me to take leaps of faith to expand my practice into new areas of focus with the reassurance of a soft landing if I had any questions or challenges. Everyone is an integral member of the team and it shows.

What is the biggest opportunity and greatest challenge facing clients in your area of focus today?
We have an exhausted industry caring for an exhausted nation. The challenges today are the same challenges that the American healthcare system has had for decades: How to innovate? How to differentiate? How to collaborate? Now that we are more than a year into the global COVID-19 pandemic, [...]

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HPE Miami 2021: Subsector Insights | Women’s Care

The field of women’s care offers investors several excellent entry points for innovation and growth. McDermott partner Joshua Spielman moderated this conversation featuring insights from Michael Chang, partner at BC Partners; Robert LaGalia, president and chief executive officer of Unified Women’s Healthcare; and Uttara Marti, managing director at Evercore.

Access the PDF here.

Women’s health continues to be one of the most fragmented sectors of the healthcare industry, which means that there are ample opportunities for new entrants and existing platforms to innovate, integrate and improve the delivery of care in this space.

Women’s care providers have an opportunity to expand their core OB/GYN and fertility focus. Providing additional wrap-around services can drive incremental value.

Women’s health is uniquely able to take advantage of value-based care arrangements, but key obstacles must be overcome first, including scale, provider buy-in and access to the necessary data.

Fertility services remain a strong driver in the women’s health space. More and more, employers are providing fertility coverage and benefits, helping to drive access and volume in this sector.

To catch up on all of the sessions from the HPE Miami 2021 Conference, please click here.

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CDC Issues Guidance for Employer-Operated Vaccination Sites

As states across the US expand COVID-19 vaccine eligibility, employers are well-positioned to facilitate vaccine access and improve distribution efficiency. One critical way for employers to achieve these goals is through the operation of workplace vaccination sites, sometimes called closed points of dispensing (CPODs).

On March 16, 2021, the Centers for Disease Control and Prevention (CDC) issued updated guidance on workplace vaccination programs. Among other recommendations, the CDC encourages some employers to implement workplace COVID-19 vaccination sites and outlines best practices for doing so.

According to the CDC, employers with (1) a large number of workers on predictable schedules, (2) the ability to enroll as a vaccination provider or engage an already enrolled vaccination provider, and (3) enough space to operate a vaccination clinic that allows for social distancing should consider operating an on-site vaccination program. Conversely, the CDC recommends an off-site vaccination program for small- or medium-sized employers with a mobile workforce on variable schedules.

The CDC provides several options for employers that choose to operate an on-site vaccination program, including existing occupational health clinics, employer-run temporary vaccination clinics, and mobile vaccination clinics brought to the workplace. Regardless of the model, the CDC advises employers to contact their local health department for guidance. Many jurisdictions have already embraced the CPOD model (e.g. Chicago, IL) and provide extensive information on their websites.

The updated CDC guidance makes clear workplace vaccination clinics should [...]

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HPE Miami 2021: Subsector Insights | Urgent Care

Greg Metz, co-head of McDermott’s Private Equity Practice Group, joined Simon Bachleda, co-founder and managing partner at Revelstoke Capital Partners; Richard Park, MD, founding chief executive officer of CityMD and co-founder of Ascend Partners; and John Randazzo, senior advisor, Warburg Pincus, to discuss how urgent care practices are expanding their service offerings and driving value.

Access the PDF here.

  1. In recent years, the service offerings available at urgent care centers have expanded beyond traditional “urgent care” into several ancillary services. “Historically, urgent care was for urgent needs, such as flu or strep or strains,” Bachleda said. “Now it has evolved to much more than just urgent, into primary care and ultimately even into multispecialty. A lot of ancillary services now can be offered seamlessly within the confines of the four walls of an urgent care center.” These include orthopedic services, and behavioral and mental health services. “As needs continue to evolve, urgent care is one of the most flexible areas of this market that is able to change with the times,” Randazzo noted.
  2. For urgent care practices, successful growth hinges upon standardizing the patient experience and developing a brand name with which patients are familiar and comfortable. “Making sure that patients know who we are and [...]

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HPE Miami 2021: Subsector Insights | Pharmacy

McDermott partner Karen Gibbs joined Matthew Thompson, general partner at Enhanced Healthcare Partners, and Drew Walk, chief executive officer at Soleo Health, in an insightful discussion of what’s next for investment in the pharmacy space.

Access the PDF here.

  1. New therapies and the accompanying technologies to deliver them make pharmacy an appealing space for investment in 2021. In particular, organizations that can find ways to effectively manage escalating costs will be successful.
  2. The COVID-19 pandemic has highlighted the value and game-changing solutions that pharmacy can bring to the healthcare ecosystem at large. Pharmacy is an end point of care, and its extraordinary innovation is driving better patient outcomes.
  3. Regulatory scrutiny is always evolving in the pharmacy industry and should remain top-of-mind for any company considering an investment in the space.
  4. A transition to true and effective value-based care in the pharmacy sector will require significant collaborating between payers, providers, suppliers and manufacturers.
  5. COVID-19 has created headwinds in this sector because pharmacy is downstream from elective surgeries and other elective care. There is a backlog of care stemming from the pandemic, however, which presents an opportunity for accelerated growth in the pharmacy space moving forward.
  6. Innovations that help establish “arm-in-arm” relationships between physicians and pharmacists will help [...]

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HPE Miami 2021: Subsector Insights | Gastrointestinal

The past year saw robust deal activity focused on gastrointestinal (GI) practices, and the sector will remain an attractive target for private equity sponsors in 2021. McDermott partner Amanda Jester moderated this panel featuring Gabriel Luft, principal at Amulet Capital; Hugh McBride, principal at Kelso; Jason Porter, managing director at Baird; and James Weber, MD, chief executive officer at GI Alliance.

Access the PDF here.

  1. GI continues to be a popular PE investment. As a specialty, GI has proven to be stable and resistant to market changes, even amid economic and political shifts. GI groups also have the potential to provide ancillary services in-house, such as infusion, anesthesiology and pathology, which can increase their profitability and efficiency of care.
  2. The ability to scale has become increasingly important as GI groups contract with payors and health systems. GI lends itself well to scale, given the lower costs of operation and the ability to add ancillary services that can also be scaled. This ability to scale will likely continue to grow the value of GI businesses as we transition to value-based care.
  3. GI practices benefit greatly from the ability to perform procedures in outpatient facilities. Many GI groups now have their own, or are partnering with, ambulatory surgery [...]

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