Tag Archives: Hospitals

Seven Thoughts When Considering Troubled Hospital Deals

hospital
Those who follow hospital and health system M&A activity know that the market has been “frothy.” We all see the high profile, “sexy” deals that appear in the news headlines but, for every large deal, there are myriad smaller deals that involve rural hospitals, county hospitals and, sole community hospitals, many of which are struggling, … Continue reading this entry

Medicare Claims Appeals: D.C. Circuit Reverses and Remands in Case Seeking Relief From Processing Delays

hospital
Summary of AHA v. Price, 2017 U.S. App. LEXIS 14887 (D.C. Cir. Aug. 11, 2017)   On August 11, 2017, the D.C. Circuit reversed the district court and held that the district court abused its discretion by ordering the Secretary of HHS to clear the backlog of administrative appeals of denied Medicare reimbursement claims within … Continue reading this entry

FTC Again Finds Success in High-Profile Hospital Merger Appeal

CMS Releases Medicare Part B Supplier Billing and Payment Data
For the second time in recent weeks, the Federal Trade Commission (FTC) prevailed in its challenge of a high-profile hospital merger. This time, the appeal stemmed from a June 14, 2016, order by Judge Jorge Alonso of the Northern District of Illinois denying the FTC’s motion to enjoin the merger of the thirteen-hospital Advocate Health … Continue reading this entry

FTC Battles Hospital Mergers: What to Watch for in this Summer’s High-Profile Appeals

CMS Releases Medicare Part B Supplier Billing and Payment Data
In a town that is no stranger to landmark hospital merger cases, last month a Chicago federal judge denied the Federal Trade Commission’s (FTC) motion for a preliminary injunction to temporarily block a merger between 13-hospital Advocate Health Care and four-hospital NorthShore University HealthSystem, both located in the city’s northern suburbs. Judge Jorge Alonso’s much-awaited, … Continue reading this entry

Legislation to Expand Definition of Grandfathered Off-Campus Hospital Departments to Address “Mid-Build” and Cancer Hospital Projects Moves Forward

A bill amending the “site neutrality” limitations brought by Section 603 of the Bipartisan Budget Act of 2015 was introduced in the House of Representatives last week and passed out of committee yesterday. H.R. 5273, the “Helping Hospitals Improve Patient Care Act of 2016,” was introduced by two powerful Members of the House Ways and … Continue reading this entry

Finance Committee Report Place Medical Device Arrangements under Increasing Scrutiny

Hospitals and providers participating in physician-owned distributorships, or “PODs” may be at increased risk for government investigation or enforcement. A Senate Finance Committee (SFC) Report issued this month highlights the SFC’s concerns that certain POD structures may violate fraud and abuse statutes, including the Anti-Kickback Statute, Stark Law, as well as the Sunshine Act. According … Continue reading this entry

At The Intersection of New Bundled Payment Programs and New Discharge Rules: Private Equity Opportunities

Recently, CMS has promulgated new bundled payment rules for Comprehensive Joint Replacement (CJR) that require the mandatory participation of approximately 800 hospitals across the US. This bundle includes not only the inpatient DRG care, but also 90 days of post-discharge care. Contemporaneously, CMS has initiated rulemaking which totally revamps the discharge planning process for hospitals by requiring … Continue reading this entry

Comprehensive Joint Replacement Bundled Payment Program Begins April 1st

Approximately 800 hospitals in 67 Metropolitan Statistical Areas will begin mandatory participation in the Comprehensive Care for Joint Replacement (CJR) Model on April 1, 2016. The CJR bundled payment program applies to MS-DRG 469 (major joint replacement or reattachment of lower extremity with major complications or comorbidities) and MS-DRG 470 (major joint replacement or reattachment … Continue reading this entry

Recent EHR Meaningful Use Program Updates

American Hospital Association Recommends Revisions to Medicare ACO Models
As we enter the sixth year of the Medicare and Medicaid Electronic Health Records Incentive Programs (commonly referred to as the “Meaningful Use Programs”), the Centers for Medicare & Medicaid Services (CMS) continues to make adjustments to the Meaningful Use Programs to better accommodate providers and suppliers. Two recent updates are described below.… Continue reading this entry

Illinois Telemedicine Rules: Licensing, Practice, Payment

Illinois is experiencing growth in telemedicine and telehealth offerings available to patients in the Prairie State. Historically, Illinois telehealth services have been more limited to hospital and institutional settings, but the last few years have since seen an expansion among providers offering such services directly to patients. And yet, Illinois remains a state that has … Continue reading this entry

Potential Part B Drug Payment Cuts for 340B Hospitals

The influential Medicare Payment Advisory Commission (MedPAC) has voted to recommend to Congress in its March report that Medicare Part B drug payment rates for 340B drugs be reduced by 10 percent for hospitals participating in the 340B Drug Pricing Program (340B Program). Currently, hospitals are paid the same rate by Medicare for drugs whether … Continue reading this entry

Transforming Oncology Care: What’s Working and What Lies Ahead

Oncology providers and payors are undertaking bold initiatives to transform our system of “sick” care into a component of the value-based system of the future. The evolving system focuses on proactively monitoring and coordinating care by a team of providers working in concert to deliver care more efficiently and keep patients healthier. From payment changes … Continue reading this entry

Five Telemedicine Trends Transforming Health Care in 2016

Telemedicine is a key component in the health care industry shift to value-based care as a way to generate additional revenue, cut costs and enhance patient satisfaction. It is expected that the global telemedicine market will expand at a compound annual growth rate of 14.3 percent through 2020, eventually reaching $36.2 billion, as compared to … Continue reading this entry

Budget Law Moves Towards Site-Neutral Medicare Payments; Join Foley for a Discussion on November 13

The recently enacted Bipartisan Budget Act (P. L. 114-74) included a provision that will significantly alter the future of hospital-based outpatient care. The provision, Section 603, will exclude from Medicare’s outpatient hospital prospective payment system (“OPPS”) any new off-campus departments of a hospital, as determined by Medicare’s provider-based standards, unless it is a “dedicated emergency … Continue reading this entry

Five Takeaways From North Dakota’s Proposed Telemedicine Rules

Electronic Health Records
The North Dakota Board of Medicine issued proposed regulations designed to move the Peace Garden State to the list of telemedicine-friendly states. The rules properly focus on the quality of care delivered, rather than the technical means through which it is delivered, aligning well with telemedicine practice rules articulated by other state medical boards. The … Continue reading this entry

Budget Bill Aims to Kill Any New Off-Campus Provider-Based Facilities

Medicare’s 60-Day Proposed Refund Rule Imposes Significant Liability on Providers
Legislation being drafted as part of a budget deal between members of Congress and the White House includes language that will significantly alter the future of hospital-based outpatient care. The “discussion draft” of the bipartisan budget agreement would exclude from Medicare’s outpatient hospital prospective payment system (“OPPS”) any new off-campus departments of a hospital, as … Continue reading this entry

Can My Hospital Bill Medicare for Telehealth Chronic Care Management?

In a word: yes, and CMS just introduced proposed rules to clarify the requirements and payment opportunities when hospitals want to bill Medicare for Chronic Care Management (“CCM”) services. CCM is an exciting service covered by Medicare and perfectly suited for telehealth, as CCM may be provided via remote care services. CCM is another way hospitals … Continue reading this entry

Cooperative Hospital Service Organizations: A Hospital Joint Venture Option

Cooperative Hospital Service Organizations (CHSOs) are organizations that are available for hospitals considering certain types of joint ventures with other hospitals. If the terms for their use strictly meet the regulatory requirements, CHSOs can provide both tax exemption and Antikickback Statute Safe Harbor protection for such joint ventures. CHSOs must be organized and operated on a … Continue reading this entry

Is Provider-Based Reimbursement Going Away?

We get this question every year: will Medicare, Medicaid or other payors continue to recognize hospital-level facility fee reimbursement for hospital outpatient departments meeting the provider-based designation criteria at 42 C.F.R. 413.65? This year, there have been suggestive developments and a few data points to consider as you evaluate your operations:… Continue reading this entry

Monetizing Real Estate: A Method to Access Capital

Medicare’s 60-Day Proposed Refund Rule Imposes Significant Liability on Providers
The financial situation for hospitals and health care organizations remains challenging. The accrediting agencies, Moody’s, Fitch, and S&P all have negative outlooks for the hospital industry. Hospitals are facing numerous revenue challenges. These challenges include the shift from inpatient admissions to outpatient procedures; slower growth in utilization, in part from the increase in consumerism and … Continue reading this entry

Medicare Announces Pay Increases for Psychiatric, Skilled Nursing and Rehabilitation Providers in Fiscal Year 2015

According to the rules released last Thursday by the Centers of Medicare and Medicaid Services (CMS), Medicare will increase payment to inpatient psychiatric hospitals, inpatient rehabilitation facilities and skilled nursing facilities in fiscal year 2015. The finalized payment policies boost reimbursement to psychiatric hospitals and rehabilitation facilities past amounts originally proposed by CMS in May … Continue reading this entry

Hospitals Urging SCOTUS to Limit False Claims Act Penalties

CMS Releases Medicare Part B Supplier Billing and Payment Data
What do a moving company and a hospital association have in common? The False Claims Act (FCA).  The American Hospital Association along with the United States Chamber of Commerce and the Pharmaceutical Research and Manufacturers of America recently submitted an amici curiae brief in support of petitioners, Gosselin World Wide Moving, urging the Supreme Court … Continue reading this entry

Critical Considerations in Healthcare Affiliations

The trend of affiliations between healthcare providers (we use the term “affiliation” to include all manner of transactions, including mergers, acquisitions, joint operating arrangements, etc.) continues at a rapid pace. Continued economic pressure brought on by decreasing Medicare reimbursement and the perceived need for scale and diversification of service offerings have healthcare providers, including many … Continue reading this entry

Could a Recent CMS Deregulation Regulation Save Health Care Providers $8 Billion?

As part of President Obama’s regulatory lookback initiative, the Centers for Medicare and Medicaid Services (CMS) issued a final rule last week (the “Rule”) that overhauled numerous staffing regulations affecting hospitals and clinics, extended deadlines for nursing homes to improve fire safety and removed certain data reporting requirements for organ transplant centers. CMS estimates that … Continue reading this entry