CURRENT AND FUTURE MEDICAL HOME LEGAL ISSUES
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1 CURRENT AND FUTURE MEDICAL HOME LEGAL ISSUES Presented by: Gerry Hinkley Co-Chair, Health Care Industry Team Pillsbury Winthrop Shaw Pittman Pillsbury Winthrop Shaw Pittman LLP
2 Session goals Understand the translation of Medical Home goals into a legally enforceable structure Address some contracting issues provider to provider; payor to provider Consider antitrust risk Weigh privacy and security concerns Look at implications for the standard of care in negligence actions 1 Legal Issues in Medical Home Development
3 Transforming the model into a system The Model s general goals Personal physician Physician directed medical practice Whole person orientation Quality and safety Enhanced access Supportive payment 2 Legal Issues in Medical Home Development
4 Components of a system Home provider a professional or group of professionals Elements of care and care coordination -- detailed description of the program: patient and provider selection and participation care paths and protocols reporting and improvement grievance resolution Determination of costs to provide this level of care Documentation Employment, home provider contracts Program plan and protocols Payor contracts Referral provider contracts HIT procurement and maintenance 3 Legal Issues in Medical Home Development
5 Payor contracts Payor business and financial support is key In exchange for support, home providers commit to Quality measures: third party (NCQA), payor-specific Programmatic measures Staffing Care protocols Reporting outcomes and patient/provider satisfaction Payor participation takes the form of payment and care management 4 Legal Issues in Medical Home Development
6 Payor contracts specific terms Payment PMPM Patient attribution methodology Evaluation Utilization expectations Quality measures Patient and provider satisfaction Termination Dispute resolution Consequences for provider status 5 Legal Issues in Medical Home Development
7 Antitrust compliance Sherman Act prohibiting unreasonable restraints on trade Is setting a range of reimbursement horizontal price-fixing? Is it a permissible restraint ancillary to a legitimate joint arrangement Do procompetitive benefits outweigh potential bad consequences? Eliminates free riders Benefits consumers Reduces costs Improves quality Implications of State Action to avoid antitrust violation 6 Legal Issues in Medical Home Development
8 Privacy and security More sharing of information than in typical model Most communications between providers should be for treatment or payment and not require HIPAA authorization HIPAA compliant authorization required to transmit out of the system e.g. PHRs State law may require specific consents Consider appropriateness of enhanced or coordinated privacy policies for trust Enhanced HIPAA responsibilities, penalties under HITECH Act 7 Legal Issues in Medical Home Development
9 Standard of care The professional must render care with the same degree of care as a reasonable member of that profession in similar circumstances would render in the community Some courts have considered resource restraints to lower the standard Will resource expansion push the standard to higher levels? 8 Legal Issues in Medical Home Development
10 Is this concierge medicine? Prohibition on additional charges to patients for covered services (Medicare and perhaps HMO contracts) can t charge an access fee for Medicare covered services (and maybe for commercial services) Do payors have a right to offset payments received from secondary payors (COB) 9 Legal Issues in Medical Home Development
11 Thank You for Participating Gerry Hinkley Co-Chair, Health Care Industry Team Pillsbury Winthrop Shaw Pittman Legal Issues in Medical Home Development
12 The purpose of this presentation is to inform and comment upon transactions in the health care industry. It is not intended, nor should it be used, as a substitute for specific legal advice as legal counsel may only be given in response to inquiries regarding particular situations. (c) Pillsbury Winthrop Shaw Pittman LLP Legal Issues in Medical Home Development
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