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
Medicare and Medicaid
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VBC Symposium 2023 | Innovations in Value-Based Care for Complex Populations

During this session, Partner Jeremy Earl moderated a panel that discussed how value-based care models are delivering care to individuals with complex conditions and those with significant healthcare and social needs. The panel also provided perspectives from executives at companies that are revolutionizing the delivery of care to high-needs populations and demonstrating how doing good can also be a successful business model.

Session panelists included:

  • Christopher Aguwa, Executive Vice President & Head of Growth and Business Development, Cityblock
  • Benjamin Kornitzer, MD, Chief Medical Officer, agilon health
  • Hank Watson, Chief Development Officer, American Health Partners
  • Lea Tompsett, Head of Provider Enablement, Waymark

Top takeaways included:

  1. Focus on Empowering and Elevating Providers. The companies that are successfully delivering care to complex populations are those that are focused on empowering and elevating providers to fill in gaps in care; such entities also succeed on cost and outcome goals as a result. These companies primarily focus on primary care providers (PCPs), nursing homes and related front-line providers. The panelists who focus their efforts on primary care do so in the belief that primary care can have the greatest impact on outcomes. Traditionally, primary care has been delivered within the four walls of a PCP’s office, with fee-for-service (FFS) reimbursement. Companies take different approaches to moving outside of this traditional model: Some focus on extending services outside of the PCP’s office to fill in gaps in care, such as deploying nurses to the home. Others seek to enable PCPs with data and [...]

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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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Proposed Changes to DSH Payment Calculation Regulations Could Impact 340B Hospitals

On February 28, 2023, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would change how Medicare disproportionate share hospital (DSH) payments are calculated with respect to the counting of days associated with Section 1115 demonstrations in the Medicaid fraction of the DSH calculation. This proposed rule is a follow-up to the FY 2022 and FY 2023 Inpatient Prospective Payment System (IPPS) proposed rules, which initially included similar proposed revisions to the treatment of certain Section 1115 waiver days for purposes of the Medicare DSH adjustment.

Comments on the proposed rule are due May 1, 2023.

Read the full article here.

HPE New York 2021: Prepare for Tomorrow

Kevin Miller—a partner at McDermott Will & Emery whose practice largely focuses on the securities, tax and regulatory aspects of complex transactions—moderated a panel during HPE New York 2021 that looked at how government actions will impact the market. The panel feature:

  • Diane Daych, Managing Partner and Co-Founder, Granite Growth Health Partner
  • Brian Fortune, Senior Managing Director, Farragut Square Group
  • Mara McDermott, Vice President, McDermott+Consulting
  • Alex Ruiz, Partner, McDermott Will & Emery
  • Thomas Scully, General Partner, Welsh, Carson, Anderson & Stowe

Access the full takeaways here.
Watch the session recording here.




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