Market forces producing the demand for hospital-physician integration and other strategic alliances include programs of clinical integration, risk-oriented contracts with major payors, ACO-type programs (whether with Medicare or a commercial payor), and the development of provider-owned payment organizations. They all share one thing in common: institutional providers and physicians must create relationships or organizations that enable cost reduction and quality improvement initiatives, and facilitate the sharing of limited dollars on an equitable basis.
Relationships between hospitals and physicians can take many forms: physician employment, physician-hospital organizations, management services organizations, gainsharing, accountable care organizations, and risk contracting with payors. Our team is well-versed in structuring strategic alliances and innovative integration and delivery strategies that enable our clients to comply with the ever-changing regulatory environment and adapt to new payment models. We also assist our clients in assessing the impact of Stark, the Anti-Kickback Statute, the Civil Monetary Penalties Law, the tax-exemption provisions of the Internal Revenue Code, and applicable state regulation of insurers and TPAs on existing and proposed arrangements.
In an environment in which provider payment is increasingly being tied to results for quality, access, and efficiency, these strategic alliances are critical. Smith Moore Leatherwood's team can help your organization achieve its relationship goals and assist in the development of more effectively integrated patient service structures.