Advocate Health Partners Obtains FTC Permission to Proceed with its Innovative Clinical Integration Program - Hogan Marren Ltd. Helps Chicago Physician Hospital Organization to Successfully Conclude 4 Year Investigation
Hogan Marren Ltd. is pleased to announce that, earlier today, the Federal Trade Commission voted unanimously to approve a consent decree in its investigation of Advocate Health Partners (AHP), a network of 2,600 independent physicians affiliated with the Advocate Health Care hospital system. Concluding the FTC's 4 year investigation of AHP, the consent decree specifically allows the AHP Clinical Integration Program to proceed, and grants permission for AHP to continue its collective contracting activities with PPOs and other fee-for-service health plans. This marks the first time that the FTC has granted such permission to a physician organization already engaged in joint contracting on the basis of clinical integration.
Since 2002, Hogan Marren attorneys John Marren and Thomas Babbo have assisted AHP both in the development, implementation, and operation of the AHP Clinical Integration Program and in its defense before the FTC. This extremely positive result, both for AHP and the concept of clinical integration as a justification for joint contracting, follows Hogan Marren's successful defense of AHP last year against insurance giant United Healthcare.
For more information about the consent decree or the topic of clinical integration, feel free to contact John Marren and Thomas Babbo. For further details about the United case, click here.
John Marren:(312) 540-4419 jpm@hmltd.com
Tom Babbo: (312) 540-4431 tjb@hmltd.com
Trustee Magazine Interview
Edward Hogan was interviewed recently for an article in Trustee Magazine entitled, "A Tale Of Two Turnarounds," by Karen Sandrick which was published in the magazine's October 2005 issue. The article is about two hospitals, their management and their boards, who refused to shut down and instead, built a foundation for the future. To read the full article, click here to visit the Trustee Magazine website.
Hogan Marren's health care practice is named among the top four in the Midwest
Hogan Marren is pleased to announce that Chambers USA ranked our Health Care Practice among the top four in the Midwest in the 2005 Client Guide. Chambers' independent researchers conducted numerous phone interviews with both clients and top practitioners, in order to compile its rankings. As the ranking states:
Interviewees described this niche player as a "smaller but highly capable" team that enjoys a respectable standing in the market. One of its key areas of strength lies in the managed care sector. Here, clients particularly praised the team for its skill in negotiating complex contracts and for assisting them in hospital-physician joint ventures. The group's work also includes advising clients on fraud and abuse compliance and on issues surrounding reimbursement. Although the group does not match some of its competitors in terms of size, interviewees were quick to point out that it has the scope to manage large projects and that it has attracted a loyal following of clients.Hogan Marren's small size and the combined experience of the health care team, consisting predominately of partners with over 20 years of experience, distinguishes itself from other ranked practices with its cost efficient, client-centered approach. The firm's aim is to form a strategic relationship where legal services are integrated with a client's business goals in a complementary fashion to further the growth and success of the client's health care mission.
Strategies for Managed Care Contracting
Managed Care contracts can form a complicated and confusing maze, made
ever more complex by the continuing expansion of provider networks and
the rapidly increasing number of enrolled members. Operational and administrative
responsibilities, as well as the extent of financial risk assumed by
a medical provider, must be carefully evaluated. Persons considering
a relationship with a managed care health plan or third party payer
should review the strategies to be considered in contract formulation,
analyze the companies or organizations that might become partners, and
assess how the relationship will evolve.
Medical Staff 2004
Hogan Marren believes that the current structure of the relationship
between the hospital governing board and the medical staff does not
support and promote quality and patient-centered care. Case law, statutory
requirements and regulatory expectations clearly state that governing
boards are ultimately responsible for the quality of patient care, and
yet governing boards delegate these functions without sufficient information
to measure and monitor quality, which can result in failures of oversight
and compliance. Hogan Marren strives to improve this structural relationship
and minimize malpractice expense and liability by educating hospital
and medical staff leadership about the effectiveness of their current
quality processes, including internal peer review; streamlining hospital
and medical staff bylaws; and integrating quality oversight into a multidisciplinary
body of board leadership, administration and medical staff leadership.
Limiting Board Liability / Avoiding Personal
Liability for Board Members
Hogan Marren is keenly aware that hospital governing bodies are ultimately
responsible and accountable for every activity that occurs within the
hospital, and thus advises governing bodies and individual directors
and trustees with respect to their collective and individual roles,
responsibilities and exposures as members of a governing board. Hogan
Marren educates governing bodies with respect to their fiduciary duties
and their duties of loyalty and care, which can include, in the hospital
setting, the appropriate and inappropriate use of charitable and community
assets. Hogan Marren then works with governing bodies to assure effective
means of hospital governance, including the proper use and implementation
of policies and procedures. Hogan Marren works with insurance companies
to assure they provide proper coverage of both governing bodies and
their individual members.
Provider Relations
The most important transaction a hospital often has is with its physician
and other provider transactions. A myriad of different laws, however,
prescribe the allowable structure of these relationships. Hogan Marren
has the expertise to help your business arrangements achieve their goals
in a lawful manner. Our firm members are experts in Stark law, Medicare
and Medicaid anti-fraud and abuse laws, Medicare and Medicaid reimbursement
laws, tax exemption laws, state prohibitions against the corporate practice
of medicine, fee splitting and self-referrals and other laws, rules
and regulations which could affect the structure of hospital relationships
with related providers and the relationship of these providers with
each other.
Executive Compensation
Hospitals and other tax exempt organizations must carefully scrutinize
their executive compensation packages to ensure they satisfy requirements
under Section 4958 (intermediate sanction law) and Section 501(c)(3)
(tax exemption law) of the Internal Revenue Code. Hogan Marren is expert
at structuring appropriate compensation plans, including compliance
not only with Section 501(c)(3) and Section 4958 concerns but also issues
related to deferred compensation and retirement planning under Section
401(k), Section 403(b) and Section 457 of the Code.
EMTALA
The Emergency Medical Treatment and Active Labor Act (EMTALA) affects
all hospitals with emergency rooms and physicians on their medical staffs.
Failure to comply with the ever-evolving EMTALA regulations can lead
to the imposition of civil monetary penalties and potential exclusion
from the Medicare/Medicaid programs for both hospitals and physicians,
and civil liability against hospitals. We have defended hospitals against
alleged EMTALA violations, and have prepared the corrective action plan
for submission to state survey agencies and appeared before the Peer
Review Organization for hearing. We have been reviewed and drafted EMTALA
policies for hospitals, and planned and provided staff education on
EMTALA compliance. We can assist hospital and physician providers in
assessing and minimizing their risk of an EMTALA violation, and monitoring
their compliance with EMTALA on an ongoing basis.
HIPAA
Compliance with the Privacy Regulations promulgated under the Health
Insurance Portability and Accountability Act (HIPAA) is a major compliance
issue for health care providers, health plans, health care clearinghouses
and those who contract and perform services on their behalf that involved
protected health information. Sorting out the relative roles and responsibilities
of business associates and covered entities can be challenging, and
affects the potential liability of all parties. We have reviewed and
drafted numerous Business Associate Agreements and Notices of Privacy
Practices, and are familiar with the issues involved in amending health
plan documents to comply with HIPAA. We have worked with a variety of
consultants in addressing HIPAA implementation, and can assist covered
entities in integrating HIPAA into their compliance programs.
Medical Care Over the Internet
Questions have been raised about the use of the Internet for communicating
information between doctors and their patients for the purpose of diagnosis
and treatment. These uses include the communication of symptoms, the
communication of an initial diagnosis, the prescription of a course
of treatment, and in some cases the prescription of medications. Numerous
questions have been raised regarding the ethics of such actions, and
in many cases, States have taken action to challenge the legitimacy
of such practices, resulting in some instances the abandonment of such
businesses. Notwithstanding these actions, there is a position that
says such practices are beneficial in that they allow for a lower cost
approach to the provision of health care services. From a legal perspective,
if these programs are to continue and develop, they must be done in
accordance with certain guidelines.
Risk Retention Groups/Captive Insurance Companies
With a professional medical liability crisis again sweeping across America,
especially in Cook County, Illinois, medical malpractice premiums are
increasing at unprecedented rates. This is forcing some physicians to
assess their ability to continue to practice in this environment. Physicians,
physician groups and hospitals are looking for creative ways to address
this situation. One method increasingly being considered is the development
of an alternative risk group, such as a risk retention groups or captive
insurance companies. Hogan Marren is working with leading captive managers,
accounting firms, underwriters, insurance companies, actuaries and third
party administrators to help clients explore the creation of these alternative
risk models.
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