1. Date|Time Company, firm, city, state, email address Title of Webinar/Roundtable Date | Time This webinar is sponsored by Faculty : Name Company/Firm, City, State Email address Name Company/Firm, City, State Email address Name (moderator) Company/Firm, City, State Email address Date|Time This webinar is sponsored by Company, firm, city, state, email address National Credentialing Forum Legal Updates in the Credentialing Process February 6, 2015 Brian C. Betner Hall Render, Killian Health & Lyman, P.C. 1

2. Is Something Different Here? Tremendous Regulatory Activity Driven by Industry Pressures – Triple Aim population health patient experience cost control – Culture of safety – Reimbursement – Money Speaks 2

3. Some Things are Undeniable  Reimbursement will be increasingly tied to quality and outcomes = value not volume  Cost reduction pressures will increase  Reduced inpatient volumes and acute care revenue  Health system/hospital diversification beyond acute care revenue (outpatient or freestanding credentialing?)  Data will be king/heavy reliance on HIT  Patient-centric, not provider- centric  Coordinated care, particularly within specific disease states  Shift away from fragmented, volume-based payments (i.e., “bundled” or “episode of care” payments)  Employers and payers demanding accountability/ transparency re: cost of care and outcomes  Shift in emphasis re primary care v. specialists  Influx of non-physician providers  Industry reform will continue to be driven by reimbursement policy

4. Credentialing, Privileging and Quality Within this new paradigm, credentialing, privileging and quality likely have the greatest impact on market and financial performance 4

5. Stream of Consciousness Case Law Themes – Antitrust: North Carolina Board of Dental Examiners v. FTC – NPDB: Reporting of Employment Actions – Peer review confidentiality encroachment HHS’s recent announcement re VBP – Goal of increasing the % of payments through VBP models to 30% by 2016 and 50% by 2018. HHS also proposed that by 2016, 85% of all Medicare FFS payments have a component that is based upon quality or efficiency of care, increasing to 95% by 2018 Clinical Integration – Is it superseding the role of the Medical Staff? System- level Activities Quality and Fraud and Abuse – Is it medically necessary? 5

6. Consciousness cont. The Role of NPs and PAs Disruptive Behavior Employed Practitioners Aging Physicians Negligent Credentialing – It’s economics Metric Apathy – Do you know how you are being measured? More with Less and the loss of experience NPDB Guidebook 6

7. Questions? 7