On May 9, 2019, the nonprofit Research and Development (RAND) Corporation published a research report, which found that private insurance companies pay approximately four times more for hospital services than Medicare. The report reviewed data from self-insured employers, state-based all-payor claims databases from Colorado and New Hampshire, and health plans during the period of 2015 to 2017. In total, these sources included approximately 4 million beneficiaries and 1,598 Medicare-certified acute care hospitals across 25 states, representing $13 billion in allowed amounts. (Read more...)  

On May 21, 2019, Avalere Health released a report analyzing the viability of a compulsory two-sided risk arrangement within the Oncology Care Model (OCM), a Medicare payment model commenced in July 2016. Significantly, the analysis found that should practices be forced to switch to a two-sided risk arrangement, more than half of them would be forced to pay recoupments back to the Centers for Medicare and Medicaid Services (CMS), meaning that participation in the OCM would no longer be justifiable for these practices. (Read more...)  

On April 29, 2019, the Florida Legislature passed House Bill 21 (largely along party lines), which repeals the state’s certificate of need (CON) laws with respect to general hospitals, specialty hospitals, and tertiary services. Pursuant to the bill, general hospitals and providers of tertiary services will be free of this requirement beginning in July 2019, while specialty hospitals will no longer be subject to the CON law starting in 2021. As of now, hospices, nursing homes, and intermediate care facilities for persons with developmental disabilities (ICF/DD) would still be subject to the CON regulations. Florida’s CON deregulation may spur other states that have also been considering CON repeals (or some variation thereof). (Read more...)  

Rural health clinics (RHCs) are statutorily-created entities, established via the Rural Health Clinic Service Act of 1977 . As such there are a number of requirements that RHCs must meet in order to become licensed and maintain Medicare certification. First, the RHC must be located in a rural, underserved area (as defined by the U.S. Census Bureau and the Health Resources and Services Administration ). Additionally, the clinic must utilize non-physician providers (NPPs) in rendering patient services – in fact, the RHC is required to be staffed with these NPPs a majority of the time. Further, these providers must comply with a range of federal and state legal and regulatory constraints, which affect their operation and transactions. This fourth installment will discuss two important regulatory issues affecting RHCs – licensure requirements and fraud and abuse law compliance. (Read more...)  
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.
HCC President, Todd Zigrang , and Vice President and General Counsel, Jessica Bailey-Wheaton , were recently published by the Chicago Medical Society in the May 2019 issue of Chicago Medicine . Read the two articles published below: