Legal and Operational Issues for Academic Medical Centers

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Presentation transcript:

Legal and Operational Issues for Academic Medical Centers Pay for Performance William D. Darling, Esq. Strasburger & Price, LLP 600 Congress Avenue, Suite 1600 Austin, Texas 78701 (512) 499-3685 bill.darling@strasburger.com DarlingB--5.01@11.15am PFP--PPT

Legal and Operational Issues for Academic Medical Centers AMCs must navigate regulatory and operational challenges in structuring their participation in P4P. This presentation will review these regulatory and operational challenges.

Legal and Operational Issues for Academic Medical Centers Navigating these regulatory and operational challenges is as important to the success of a P4P system as the more recognizable P4P issues such as: Adoption of valid clinical indicators Development of scorecards Coordination of episodes of care Reimbursement methodologies

ACADEMIC MEDICAL CENTER ORGANIZATIONAL SCHEME Single Entity AMC AMC Organization EMPLOYED PHYSICIAN SERVICES DEPARTMENTS Radiology Surgery Pediatrics Orthopedic Surgery Urology Primary Care Cardiology HOSPITAL SERVICES IN PATIENT OUT PATIENT Outside Payors AMC- Owned HMO Payor Payor Contract Contract

ACADEMIC MEDICAL CENTER ORGANIZATIONAL SCHEME Joint Contracting Foundation Faculty Practice Plan Radiology Surgery Pediatrics Orthopedic Surgery Urology Family Practice Academic Hospital In Patient Out Patient Medical School Paid Physician Faculty Affiliation Affiliation Agreement Agreement Payor Payor Imaging Center AMC Sponsored Contracting Organization Payors

Legal and Operational Issues for Academic Medical Centers Pay for Performance William D. Darling, Esq. Strasburger & Price, LLP 600 Congress Avenue, Suite 1600 Austin, Texas 78701 (512) 499-3685 bill.darling@strasburger.com