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President Trump Issues Executive Order on ACA

On January 20, 2017, President Donald J. Trump signed an executive order (The Order) regarding reforms to the 2010 Patient Protection and Affordable Care Act (ACA).  The Order's impact on existing regulations and guidance issued pursuant to the ACA is likely of limited significance; however, it does indicate the clear intention of the Trump Administration to pursue more effective and material changes to the ACA.  The legal effect of the Order on the ACA will likely be negligible, as it is restricted to merely guiding certain executive branch officials on where to broadly divert their resources.  Despite its limited impact, an understanding of the Order in its entirety shows it will, in fact, significantly affect the ACA, and provides an outline of the more powerful actions the Trump Administration will take in regard to the ACA and healthcare reform generally.  This Health Capital Topics article discusses the contents of the Order and analyzes its practical effects on the ACA and the healthcare industry in general, as well as its limitations.

On January 20, 2017, President Donald J. Trump signed an executive order (The Order) regarding reforms to the 2010 Patient Protection and Affordable Care Act (ACA).  The Order's impact on existing regulations and guidance issued pursuant to the ACA is likely of limited significance; however, it does indicate the clear intention of the Trump Administration to pursue more effective and material changes to the ACA.  The legal effect on the ACA will likely be negligible, as it is restricted to merely guiding certain executive branch officials on where to broadly divert their resources.  Despite its limited impact, an understanding of the Order in its entirety shows it will, in fact, significantly affect the ACA, and provides an outline of the more powerful actions the Trump Administration will take in regard to the ACA and healthcare reform generally.  This Health Capital Topics article discusses the contents of the Order and analyzes its practical effects on the ACA and the healthcare industry in general, as well as its limitations.  (Read more...) 
In January and February of 2017, the U.S. Department of Justice (DOJ) won both of its antitrust cases involving two widely publicized mergers of four of the nation's five largest health insurance companies: (1) Anthem with Cigna; and (2) Aetna with Humana.  In both cases, the DOJ alleged that the mergers would have anti-competitive effects on various health insurance markets in violation of federal antitrust laws, most notably Section 7 of the Clayton Act, the portion of federal antitrust law addressing mergers and acquisitions.  The Anthem-Cigna merger, a proposed $54 billion transaction, may have impacted large-employer sponsored policies in dozens of insurance markets across the nation,  whereas the $37 billion Aetna-Humana merger may have impacted the Medicare Advantage (MA) market in 364 counties across 21 states, as well as the public exchange markets in 17 counties across 3 states.  The decision in each case stands in contrast to the national trend toward consolidation in the healthcare industry, spurred, in part, by the Patient Protection and Affordable Care Act (ACA).  This Health Capital Topics article summarizes the facts of each case, recaps the court's rationale to enjoin the mergers, and explores the potential immediate and long-term ramifications of the decisions, including how the new Trump Administration may address antitrust issues. (Read more...) 
On January 9, 2017, the Supreme Court of the United States denied certiorari in the case U.S. ex rel. Willette v. University of Massachusetts (Willette),  a case from the U.S. Court of Appeals for the First Circuit holding that the University of Massachusetts Medical School (UMMS) is "not a 'person' subject to suit under the [False Claims Act] FCA" because it serves as an "arm of the state," thereby affirming the lower court's dismissal of a suit against the educational institution by a private party under this statutory scheme.  Because the case limits the ability of qui tam plaintiffs to bring lawsuits against healthcare providers under the FCA, the decision may have a significant impact on the regulatory risk held by state-affiliated healthcare enterprises, given that over $1.8 billion of the $3.3 billion recovered by the U.S. Department of Justice (DOJ) and U.S. Department of Health and Human Services (HHS) due to healthcare fraud and abuse stemmed from qui tam actions under the FCA.  This Health Capital Topics article provides a summary of the Willette case, and discusses the potential impact the case may have on the regulatory environment within the healthcare industry. (Read more...)
The Republican Party, which controls the Office of the President and both houses of Congress, and their plans to "repeal and replace" the Patient Protection and Affordable Care Act (ACA) have gained new urgency. Republicans have not currently put forth an omnibus plan for replacement; however, various Republican lawmakers have introduced ACA replacement plans, many of which contain medical malpractice tort reform elements. Republican lawmakers believe that medical malpractice is a major issue driving healthcare costs upward. Many prominent Republican politicians assert that the cost of malpractice is crippling, estimating total payouts per year to range from $100 billion to $800 billion. The movement to "repeal and replace" offers an opportunity for Republican lawmakers to make broad changes to medical malpractice law. Conservative Republican Congressmen are pushing for a quick repeal of the ACA, which is likely to be based on previous hallmarks of healthcare reform set forth by Republicans, such as tort reform. This Health Capital Topics article is the first in a three-part series that will examine the current state of tort reform in America in light of the transition to a new president. This first article explores Republican lawmakers' stances toward malpractice reform and how the current initiatives relate to proposed plans to repeal and replace the ACA. (Read more...)
ANNOUNCING

Advanced Distance Education to Launch in 2017

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 the summer of 2017 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 leaders Robert James Cimasi, MHA, ASA, MCBA, FRICS, CVA, CM&AA, Chief Executive Officer, and Todd A. Zigrang, MBA, MHA, FACHE, ASA, President of Health Capital Consultants, alongside a blockbuster faculty of healthcare subject matter experts from the legal, federal regulatory, and valuation professions.
HCC CEO Bob Cimasi Recognized as a "Pioneer of the Profession" 
under NACVA's "Industry Titans" Awards

HCC CEO Robert James Cimasi, MHA, ASA, FRICS, MCBA, CVA, CM&AA, has been
named a "Pioneer of the Profession," by the National Association of Certified Valuators and Analysts (NACVA) and Consultants Training Institute (CTI) as part of their Silver Anniversary recognition luncheon of valuation "Industry Titans," which distinguishes those whom have had the greatest impact on the profession.  Mr. Cimasi joins valuation profession luminaries, including: Dr. Shannon P. Pratt, Chris Mercer, James R. Hitchner, Roger J. Grabowski, Richard Wise, Jay E. Fishman, Nancy Fannon, Honorable Judge David Laro, Howard Lewis, and Mel H. Abraham, along with fourteen others, in receiving this honor. Congratulations to Bob Cimasi and his fellow "Pioneer of the Profession" honorees from the HCC Team and Topics Staff!