Community Health Systems Settles with OIG for $262 Million

On September 25, 2018, the U.S. Department of Justice (DOJ) announced a $262 million settlement with Health Management Associates, LLC (HMA), over fraud and abuse allegations. The former U.S. hospital chain (which is now owned by Community Health Systems [CHS]) agreed to the settlement, and to transmit payment in October 2018. The settlement resolves criminal and civil claims (which civil claims arose from eight separate whistleblower suits) that “ HMA knowingly billed government health care programs for inpatient services that should have been billed as outpatient or observation services, paid remuneration to physicians in return for patient referrals, and submitted inflated claims for emergency department facility fees. ” (Read more...)

DOJ Approves CVS-Aetna Merger

On October 10, 2018, the U.S. Department of Justice (DOJ) approved the proposed merger of CVS Health Corporation and Aetna, Inc. CVS publicly announced their intent to acquire Aetna in December of 2017 upon unanimous approval by the boards of directors of each company, combining the largest retail pharmacy chain and the third largest health insurance company in the U.S., respectively. This $69 billion merger, financed by CVS, was initiated on their belief that the transaction would fulfill an unmet need of consumers (i.e., patients) in the healthcare system, providing low cost, high quality care through the integration of Aetna’s analytical capabilities and CVS’s vast market presence. (Read more...)

Value Based Reimbursement

Does It Work?

The 2010 Patient Protection and Affordable Care Act (ACA) accelerated the transition from traditional fee-forservice (FFS), volume-based reimbursement to value-based reimbursement (VBR), by introducing a variety of new initiatives and payment models. Although the volume-to-value transition is now several years old, data regarding the effectiveness of these programs is still minimal, and the analyses of the data that is available often contradict each other. Two recent examples of VBR models include accountable care organizations (ACOs) and bundled payment models, such as the Bundled Payment Care Improvement (BPCI) Initiative and the Comprehensive Care for Joint Replacement (CJR) model, both of which models were recently examined as to their effectiveness in reducing healthcare spending. (Read more...)

Valuation of Dialysis Centers: Introduction

Dialysis centers will face significant opportunities and challenges in the near future as a result of the current conditions in the reimbursement, regulatory, competitive, and technological environments in which these providers operate. Chief among these challenges is the projected rise in demand for healthcare services resulting from the increased life expectancy of dialysis patients, the aging of the “ baby boomer ” population, and the growing prevalence of ESRD, which indicates that higher utilization of ESRD-related services for the aging population is likely to occur. (Read more...)

ANNOUNCING

Advanced Distance Education to Launch in 2019

The Institute for Healthcare Valuation (IHV) & Consultants' Training Institute (CTI) are pleased to announce premier healthcare valuation training through a distance education program, the Certificate of Educational Achievement (CEA) for Advanced Education in Healthcare Valuation. The program will launch in 2019 and will bridge the interdisciplinary nature of healthcare valuation to include: the Four Pillars of Healthcare (regulatory, reimbursement, competition, and technology); the market forces shaping the U.S. healthcare industry; and the valuation of healthcare enterprises, assets, and services. Legal professionals and healthcare providers, as well as those wishing to expand their scope of activities in healthcare valuation engagements and those seeking to enhance their current healthcare valuation service lines, will gain comprehensive knowledge through completing the expansive program. The program has been developed and is being presented by industry thought leader Health Capital Consultants , alongside a blockbuster faculty of healthcare subject matter experts from the legal, federal regulatory, and valuation professions.

HCC President, Todd Zigrang , and Vice President and General Counsel, Jessica Bailey-Wheaton , were recently interviewed by the National Association of Certified Valuators and Analysts (NACVA) , where they discussed the development of the distance education program along with the topics that will be covered. Click HERE to watch the entire interview.