HomeSolutions Medical Home MarketplaceSpencer Fane Britt & Browne LLP

Medical Home Marketplace

Helping you chart your course through health care reform

The goal of health care reform is clear:  improve access to care, fully utilize electronic health records, develop patient-centered integrated delivery systems, transition to outcome-based payment models, achieve enhanced efficiencies and improved quality, bend the cost curve.

The challenge is to navigate the obstacles obscuring that goal:  complicated regulatory requirements, aggressive government enforcement, strained hospital-physician relationships, structures built on fee-for-service payment models, absence of accountability measures, limited financial resources, resistance to change.

Physicians and hospitals know meeting these challenges will require a complete paradigm shift. Spencer Fane stands ready to chart this new course  for its clients.

Under the leadership of our seasoned health care attorneys, Spencer Fane has devised strategies and created imaginative programs that will enable providers to survive and flourish during this time of unprecedented change. We have constructed new models for health system structures, hospital-physician relationships, physician organizations, and provider networks and have mapped out compliance strategies for clients grappling with perplexing regulatory requirements.

Our representative experience demonstrates the breadth of our knowledge and our ability to devise and implement creative solutions to the challenges facing health care providers:

• Created the alliance of a rural hospital with a regional hospital system through the “virtual merger” concept by developing a new management company through the mutual investment of the rural hospital and system hospital. This alliance allowed the rural hospital to maintain its autonomy while gaining needed investment and management expertise from the system, and benefited the system by expanding and consolidating its service area.
• Assisted a hospital in negotiating the purchase of a large specialty practice and developed employment agreements and a unique collaborative management structure to facilitate the hospital’s development of a specialty center of excellence as a vital new service to the community.
• Advised a physician-owned hospital in its sale to a tax-exempt hospital system.
• Merged several radiology practice groups into a group practice without walls. The resulting group was made up of more than sixty radiologists, allowing them to gain marketing power and geographic coverage in a major metropolitan area.
• Created an independent practice association (IPA) of fourteen OB/GYN practices representing more than sixty physicians to enhance the billing, management, and marketing functions for the practices involved.
• Assisted a physician practice in developing a physician practice management organization to gain investment dollars and provide support services for several physician groups in the area.
• Created a physician-hospital organization (PHO) for a large children’s hospital that integrated administration and the medical staff in an effort to gain efficiencies and align incentives.
• Helped a hospital create and license a wholly-owned HMO and the related business structure to develop a provider network to contract with employer groups.
• Advised and represented several preferred provider organizations (PPOs) concerning utilization of the messenger model for contract negotiations
• Assisted a large national HMO in selling its business in a large metropolitan area to another large national health plan and exiting the market in a manner that protected its members’ health plans.
• Prepared model medical staff governance documents for state hospital associations, which now are the standard formats used in those states. Collaborated with several hospital medical staffs to update and revise medical staff governance documents to satisfy federal and state licensure requirements and accreditation standards.
• Represented hospitals and physicians in matters relating to provider credentialing, including fair hearings proceedings and reporting to the National Practitioner Data Bank.
• Assisted several hospitals and physicians in developing exclusive provider arrangements for hospital-based physicians (e.g., anesthesiology, radiology, pathology).
• Represented licensed individuals (physicians, nurses, dentists, pharmacists, therapists) in the course of state disciplinary actions.
• Developed a comprehensive compliance program for large multi-specialty physician group to meet requirements of an OIG corporate integrity agreement.
• Conducted a compliance program audit for a large health system and developed new strategy to enhance the program’s operations.
• Developed HIPAA Privacy and Security Rule compliance manuals and provided in-house training for numerous health care providers and health plans.
• Drafted EMTALA policies and presented related employee training for dozens of hospitals and their medical staffs, and successfully represented hospitals and physicians in EMTALA-related enforcement actions.
• Supported several providers in responding to government programs and private payer audits.