On June 17, 2021, the Supreme Court of the United States (SCOTUS) rejected, for the third time, a legal challenge to the Patient Protection and Affordable Care Act (ACA). A 7-2 majority found that the two individual and 18 state plaintiffs did not have standing, stating, “the plaintiffs…failed to show a concrete, particularized injury fairly traceable to the defendants’ conduct in enforcing the specific statutory provision they attack as unconstitutional.”  The Court ruled only on the standing issue and thus declined to proceed and rule on the constitutionality of the Individual Mandate. This Health Capital Topics article will discuss the background and procedural history of the case, as well as the analysis contained in the Court’s decision. (Read more...)

Many accountable care organizations (ACOs) received disappointing news on May 21, 2021, when the Centers for Medicare & Medicare Services (CMS) announced that it would not be extending the Next Generation ACO (NGACO) model for 2022. After five years and a dwindling number of participating ACOs, experts were split on whether or not CMS should keep the model in place for another year. On one hand, stakeholders have argued for the NGACO model’s extension until it can be replaced with or integrated into another program; however, others asserted that resources could not be properly invested with only one more year left in the program. (Read more...)

Walmart, the world’s largest retailer, opened the first Walmart Health in 2019 with the main goal of helping to meet the healthcare needs of the communities they serve. After opening six locations in almost two years, Walmart is looking to operate a total of 22 standalone clinics by the end of 2021. This Health Capital Topics article will review Walmart Health’s approach to delivering primary care, the communities into which it is expanding, its partnerships it is developing in the healthcare sector, and the competitive landscape in which it operates. (Read more...) 

A June 2021 PricewaterhouseCoopers (PwC) report found that healthcare costs have been on a steady decline for the past decade, but trailing effects from the COVID-19 pandemic could cause increases above anticipated rates over the next several years. In 2007, the annual cost growth for healthcare spending was 11.9% and declined steadily until 2017, where it floated between 5.5% and 6.0% until 2020. However, projected healthcare cost growth for 2022 is expected to reach 6.5% due to factors such as deferred or forgone care, increased mental health issues, preparation for future pandemics, and investment in digital tools. (Read more...) 
"Telemedicine's Post-Pandemic Outlook," authored by HCC President, Todd A. Zigrang, MBA, MHA, FACHE, CVA, ASA, and, HCC Vice President and General Counsel, Jessica Bailey-Wheaton, Esq., was published by St. Louis Metropolitan Medical Society in The St. Louis Metropolitan Medicine Magazine.

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.