When President Joe Biden was elected in 2020, there was much anticipation and speculation regarding what his election would mean for the U.S. healthcare industry in the coming years. As an ardent supporter of the Patient Protection and Affordable Care Act (ACA) who campaigned on offering a public insurance option similar to Medicare, many in the healthcare industry assumed that the Biden Administration would be a strong proponent of continuing the shift to value-based care, which shift was largely spurred by his predecessor and former boss, Barack Obama, with the passage of the ACA. (Read more...)

Utilizing data from FAIR Health, the Urban Institute conducted an October 2021 study which reviewed commercial insurance claims across the U.S. (for approximately 60 insurers and third-party administrators covering over 150 million Americans under age 65) from March 2019 through February 2020. This study assessed the gap between commercial insurance payments and Medicare payments for professional physician services to determine whether the payment gap between Medicare and commercial insurance differs by specialty. (Read more...)

The COVID-19 pandemic has served as a catalyst for two current healthcare workforce trends: the Great Retirement and the Great Resignation. While the Great Resignation among physicians and other clinicians has been well reported, a potential onslaught of retirements by senior executives may further impact hospitals and health systems at an already precarious time. This Health Capital Topics article will discuss some of the key challenges and issues surrounding healthcare’s Great Retirement and Great Resignation. (Read more...) 

As noted in the first installment of this five-part series, internal medicine is the largest specialty among physicians and an understanding of the various environments in which these physicians operate is crucial in determining their numerous value drivers. In particular, healthcare reimbursement, the process by which private health insurers and government agencies pay for the services of healthcare providers (including internists), is perhaps one of the most important environments to understand, as it comprises a provider’s expectation of future return on investment. This second installment will discuss the reimbursement of internal medicine services. (Read more...) 

For more recently published material written by HCC, please visit www.healthcapital.com

This one-hour webinar provides legal and valuation perspectives on the finalized changes to the Stark Law and the Anti-Kickback Statute. Specific issues covered include:

  • The changes to the “big three” requirements – Fair Market Value, Commercial Reasonableness, and the Volume or Value Standard;
  • The new exceptions and safe harbors for value-based arrangements, including where the Stark Law and Anti-Kickback Statute final rules differ; and
  • Other new and modified exceptions and safe harbors included in the final rules.