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Accountable Care Organizations Series
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When analyzing this new aspect of healthcare, there is a proverb to keep in mind,
“I KEEP six honest serving-men
(They taught me all I knew);
Their names are What and Why and When
And How and Where and Who.”1
Under the Patient Protection and Accountable Care Act, Accountable Care Organizations (ACOs) were touted as the new redeemer of the American healthcare industry, promising to lower costs and increase quality for patients and providers. Within the context of these challenging expectations, significant questions have arisen among key industry stakeholders. Health Capital Topics’ new series will explore questions surrounding ACOs within the framework of Kipling’s proverb, i.e. why, what, who, where, when, and how.
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 Accountable Care Organizations Series: Who Are ACOs?
ACOs are integrated care networks designed to lower costs and increase quality through patient care coordination. While the ACA and CMS proposed rule, issued on March 31, 2011, set federal guidelines and measures for the formation of ACOs, private development of these emerging organizations outside of the proposed rules may lead to a diverse set of stakeholders, including: providers; payors; patients; and, regulators.
(Read more...)
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Insurers Subject to ERISA Liability
In June 2011, the Ninth Circuit overturned 26 years of precedent when ruling that damaged parties may hold insurers, benefit plans, and plan administrators liable for denial of benefits under the Employee Retirement Income Security Act (ERISA). While previous rulings suggest that eligible defendants are limited to a benefit plan or benefit plan administrators, the Cyr v. Reliance decision expands the scope of liability in ERISA claims..
(Read more...)
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Statutory Elimination of Physician-Owned Hospital Exceptions
On July 1, 2011, CMS released the proposed rule fully implementing provisions in the ACA that essentially eliminate the whole hospital and rural provider exceptions to Stark Law. The changes surrounding the Stark Law in the ACA will have a significant effect on the growth, competition, and continued existence of physician-owned hospitals.
(Read more...)
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Supreme Court Overturns State Law Restrictions on Data-Mining
On June 23, 2011, the U.S. Supreme Court in a 6-3 decision overturned a 2007 Vermont law that restricted data-mining companies from using and selling individual doctor’s prescribing patterns without the physician’s permission. This ruling will have significant effects on states’ approach to the pharmaceutical industry and healthcare expenditures.
(Read more...)
1 “The Elephant’s Child” By Rudyard Kipling, Just So Stories, New York, NY: Garden City, 1912.
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