Practice Strengths

Now that the precedent-setting national health care reform legislation has been signed into law, clients across various industries are eager to understand the potential impact on their business. Baker Hostetler has positioned itself as a leading source of information on the intricacies of the new law.

Our attorneys, analysts and legislative professionals followed the proposed legislation throughout its life cycle, providing us with a deep understanding of the final law. To address those aspects of health care reform most likely to have an impact on businesses, and on healthcare industry providers and insurers, Baker Hostetler has assembled a comprehensive cross-practice Health Care Reform Group that includes representatives from our experienced Healthcare Industry, Employee Benefits, Tax, Employment and Labor and Legislative Teams. Through this collaboration, we bring clients the most up-to-date information on implementation and significant milestones for businesses, employers, hospitals, physicians and insurers. The group also works with clients to develop customized, creative solutions for reform-related issues employers and providers may face.

With seasoned practitioners on the Health Care Reform Team, Baker Hostetler is poised to assist clients navigate the complexities that lie ahead.

Our lawyers closely follow developments in health care reform and will keep you updated on such reform topics as:

For Hospitals and Providers:

• Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act
• Health Care Reform Basics for Hospitals and Providers 
• 340B Program Changes 
• Accountable Care Organizations 
• Physician-Hospital Alignment 
• Webinars, Presentations, Publications and Other Materials

Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act

Earlier this year, President Obama signed into law two sweeping health care reform bills (frequently referred to together as “PPACA” or the “health care reform law”). The first of the two acts, the Patient Protection and Affordable Care Act was signed into law on March 23, 2010. The second of the two acts or the “reconciliation bill,” the Health Care and Education Reconciliation Act of 2010, was signed into law on March 30, 2010.

Alerts:

• 10/13/2011—OIG Work Plan Highlights PPACA and ARRA Initiatives
• 10/13/2011—Comprehensive Primary Care Initiative Builds on Patient-Centered Medical Home Concept
• 10/13/2011—2009 Demonstration Offers Insights on Bundled Payments Initiative
• 9/1/2011—A Sign of the Times: The CMS Bundled Payments for Care Improvement Initiative
• 8/18/2011—The Budget Control Act and Its Potential Impact on Healthcare Policy and Institutions
• 7/21/2011—Treasury and IRS Offer Interim Guidance on Community Health Needs Assessment
• 7/21/2011—CMS Publishes Proposed Physician Fee Schedule Rule
• 7/21/2011—CMS Publishes Proposed Rule Regarding Hospital Outpatient Prospective Payments and Ambulatory Surgical Center Payments
• 7/21/2011—CMS Announces Demonstration Project on Complex Diagnostic Lab Tests
• 5/13/2010—Health Reform Implementation—Key Developments; Early Progress
• 5/13/2010—Health Reform: Beyond the Basics—What Every Business Needs to Know
• 4/8/2010—Health Care Reform: Employer Advisory
• 4/5/2010—Health Care and Education Reconciliation Act of 2010 (H.R. 4872): Summary of Main Tax-Related Provisions
• 4/1/2010—A Baker’s Dozen of Significant Changes in Health Reform
• 1/21/2010—Outlook on Health Reform: The Clock is Ticking
• 1/5/2010—House and Senate Health Care Proposals—Comparison of Key Tax Provisions

Resources:

• Unofficial consolidated version of PPACA and HCERA

Health Care Reform Basics for Hospitals and Providers

Healthcare laws and regulations are more fluid than ever as lawmakers and regulators endeavor to implement the landmark health reform legislation. Providers now must begin the process of positioning themselves strategically to assure that they are prepared for the crush of changes applicable to their existing operations and for the impact of the many new payment and delivery system models established nder PPACA. Additionally, providess must heed the call for enhanced quality in exchange for payment and recognize that their institutions and businesses will be subject to heightened scrutiny with regard to coverage, payment and compliance not only under the Medicare and Medicaid programs, but also private insurance plans.

Articles:

• 4/7/2011—ACOs, Shared Savings and the Brave New World of Regulation
• 3/17/2011—Florida Federal Judge Stays His Decision, Government Files Appeal and Review is Fast-Tracked by 11th Circuit
• 3/17/2011—HHS Releases Proposed Rule on Waivers for State Innovation
• 3/3/2011—New CMS Guidance on the Affordable Care Act’s MOE Provisions
• 12/9/2010—Health Reform’s Untold Story—Restructuring Precedes Regulation
• 10/28/2010—ACOs—NCQA Releases Standards and Measures; Seeks Public Comment
• 9/30/2010—FTC, CMS and OIG to Conduct ACO Workshop
• 9/30/2010—CMS Posts Stark Self-Disclosure Protocol
• 9/30/2010—Seventh Circuit Allows Research Time in IME FTE Count
• 9/30/2010—New CMS Rule Tightens Provider Screening Requirements
• 7/8/2010—CMS Open Door Forum on ACOs—CMS Wants Your Feedback!
• 6/24/2010—Delivery System Reform Is More Than ACOs
• 6/24/2010—ACOs—Will Physicians Lead the Way?
• 6/24/2010—PPACA’s New Patient’s Bill of Rights
• 6/24/2010—PPACA—OCIIO to Launch Insurance Options Portal
• 6/10/2010—CMS Shares Thoughts on ACOs and Shared Savings Programs
• 5/13/2010—Health Reform—340B Program Changes
• 5/13/2010—Health Reform Implementation—Key Developments; Early Progress
• 5/13/2010—Health Reform: Beyond the Basics—What Every Business Needs to Know
• 4/29/2010—New Federal Oversight Structure for Market Reforms
• 4/29/2010—Let the Rulemaking Begin...!
• 4/15/2010—The Devilish Details
• 4/1/2010—A Baker’s Dozen of Significant Changes in Health Reform
• 3/18/2010—Health Reform or Not, Changes in Physician-Hospital Alignment Are Here
• 3/4/2010—Health Reform—New Activity and Expired Deadlines
• 2/18/2010—Together We May Prosper: The Demand for Healthcare Reform and Two Innovative Models for Physician-Hospital Alignment
• 2/4/2010—The President’s FY 2011 Budget Request—A Health Reform Workaround?
• 1/21/2010—Outlook on Health Reform: The Clock is Ticking
• 1/21/2010—Health Reform’s Impact on Providers as Employers: Key Issues to Consider
• 12/10/2009—While Debate Looms Over Senate—Delivery System Reform APpears Poised for Passage
• 11/12/2009—The House Reform Bill—Winners and Losers; Revenue-Raisers; Next Steps
• 10/29/2009—Speaker Pelosi Unveils New Version of House Bill
• 10/1/2009—America’s Health Future Act of 2009: Revenue Provisions and Other Tax Changes
• 9/17/2009—The Storms of August Blow Into September
• 8/6/2009—Four Committees Done; One to Go
• 7/23/2009—Putting the Puzzle Together
• 6/25/2009—House Reform Bill Eliminates Physician-Owned Hospital Exception; Includes New and Enhanced Fraud Deterrents
• 6/11/2009—Healthcare Coverage in a Post-Reform World
• 5/28/2009—Third Roundtable Addresses Proposals for Financing Health Reform
• 5/14/2009—Second Roundtable Addresses Options for Expanding Coverage
• 5/14/2009—Second Policy Options Paper Offers Details for Reforming Everything Including the Kitchen Sink
• 5/14/2009—Medicare Payment Changes Detailed in Obama’s Line-Item Budget Request
• 5/14/2009—Health Industry Groups Pledge to Reduce Spending
• 4/30/2009—Helath Reform Update: Initial Roundtable Discussion, Policy Options Add Momentum
• 4/16/2009—Health Reform Moves Ahead: White House Establishes Office for Health Reform
• 4/16/2009—Congressional Budget Blueprint Provides for Reform
• 4/2/2009—Baker Hostetler Clients and Friends Hear From Congressional Leaders on Health Care Reform
• 3/19/2009—March Madness Comes Early to Health Reform
• 3/5/2009—The President’s 2010 Budget—A Down Payment on Health Reform?
• 12/11/2008—Obama-Biden Transition Team Update
• 11/13/2008—Health Care Reform—Senator Baucus Unveils His “Call to Action”
• 10/30/2008—Assessing the Candidates’ Health Care Plans—Does It Matter?
• Webinars, Presentations, Publications and Other Materials

340B Program Changes

Historically, the 340B Drug pricing program has allowed certain hospitals and federal grantees and federally qualified health center look-alikes to purchase outpatient drugs at heavily discounted prices. PPACA expanded the types of hospitals and entities eligible to participate in the program.

Alerts:

• 5/13/2010—Health Reform—340B Program Changes

Physician-Hospital Alignment / Accountable Care Alignment (ACOs)

A number of cost savings initiatives in PPACA are aimed at improving efficiency through alignment. As reimbursement trends and increasing costs require physicians and hospitals to do more with less, investigating alternative alignment models may offer a solution to this demand. Through models such as gainsharing, co-management and ACOs, hospitals and physicians may collaborate to provide safe, quality care more efficiently.

In broad terms, an ACO is a network of healthcare organizations and providers, including primary care physicians, specialists and hospitals, that can be held accountable for the cost and quality of care delivered to a group of identified patients. As was the case with HMOs, the theory behind ACOs is that greater coordination and cooperation among providers can result inhigher quality care and, consequently, a healthier patient population that is less costly to care for.

ACOs differ from the bundled payment options under PPACA by promoting efficiency and care on a conitunig basis rather than focusing on a single medical episode. ACOs also are distinguishable from the medical home model, which typically emphasizes preventive and primary care and often excludes specialists and hsspitals. ACOs typically mannage the full continuum of care for their members.

PPACA mandates that CMS establish and ACO-based Medicare shared savings program by January 1, 2012.

Alerts: 

• 11/10/2011—Antitrust Enforcement and ACOs
• 10/27/2011—A Baker’s Dozen of Key Highlights From the ACO Final Rule
• 4/7/2011—ACOs, Shared Savings and the Brave New World of Regulation

Articles:

• 12/8/2011—Payment Under the ACO Final Regulations: It's All in the Math!
• 12/8/2011—FTC Commissioner: What’s So Great About ACOs?
• 8/18/2011—Pioneer ACOs—CMS Clarifies Requirements
• 10/28/2010—ACOs—NCQA Releases Standards and Measures; Seeks Public Comment
• 9/30/2010—FTC, CMS and OIG to Conduct ACO Workshop
• 7/8/2010—CMS Open Door Forum on ACOs—CMS Wants Your Feedback!
• 6/24/2010—Delivery System Reform Is More Than ACOs
• 6/24/2010—ACOs—Will Physicians Lead the Way?
• 6/10/2010—CMS Shares Thoughts on ACOs and Shared Savings Programs
• 4/1/2010—A Baker’s Dozen of Significant Changes in Health Reform
• 3/18/2010—Health Reform or Not, Changes in Physician-Hospital Alignment Are Here
• 2/18/2010—Together We May Prosper: The Demand for Healthcare Reform and Two Innovative Models for Physician-Hospital Alignment
• 12/10/2009—While Debate Looms Over Senate—Delivery System Reform Appears Poised for Passage
• 11/12/2009—The House Reform Bill—Winners and Losers; Revenue-Raisers; Next Steps
• 9/17/2009—The Storms of August Blow Into September

Health Care Reform Webinars, Presentations, Publications and Other Materials

As the discussion about health care reform continues, businesses in every industry are inundated with information about the potential effects of the legislation. Attorneys in Baker Hostetler’s Healthcare Industry, Employee Benefits, Tax, Employment and Legislative Teams have offered periodic webinars to cut through the clutter, addressing key issues in greater depth and providing practical guidance you can put to use today. Many members of our Health Care Reform Team are recognized leaders in their fields, and as a result, are much in demand for speaking engagements on health care reform throughout the country, as well as contributions to well-known publications and other events.

• “Shifting Political Winds: The Impact on the Healthcare Industry,” Baker Hostetler Webinar (12/17/2010)
• “What the Health Care Reform Act Means for Hospitals, Academic Medical Centers, Physicians and Patients,” Baker Hostetler Webinar (5/19/2010)
• “Healthcare Reform 360°: Policy, Politics and Provider Implications,” Baker Hostetler Webinar (10/29/2009)
• “Health Care Reform—What’s Next?” presentation by Susan Feigin Harris at the State Bar of Texas Annual Meeting (6/11/2010)
• “All Eyes on Quality: The Increasing Role of Quality in Federal Program Payment and Enforcement Policies,” presentation by Gregory N. Etzel at the University of Texas Health Law Conference (6/11/2010)