FTC & Attorney General Launch Inquiry into a Nevada ACO
ModernHealthcare.com is reporting that the Nevada Attorney General’s office and the Federal Trade Commission have launched an inquiry into a patient-care collaboration between Reno-based Renown Health and a local cardiology practice. The publication indicates that Renown Health, a not-for-profit health system, confirmed the “informal inquiry.”
Based on the write-up by ModernHealthcare.com, Renown’s Institute for Heart & Vascular Health and Sierra Nevada Cardiology Associates formed a partnership as a first step the two providers are taking in forming an accountable care organization (ACO). The report suggests that Renown also is also in discussions with Reno Heart Physicians to form a similar agreement, but apparently the FTC and Nevada Attorney General’s office first want a closer look at the arrangements. The article also writes that a spokeswoman for Renown has stated:
Their interest is not unexpected given the size of the transaction, and we’ve met and are cooperating and providing requested information . . .
The forgoing may strike fear into many collaboratives and pilots that are in a similar position of trying to move forward with planning and developing the necessary clinical, technological and organizational structure that will allow them to operate an ACO by the January 1, 2012 deadline currently set under the PPACA. However, because the PPACA regulations have not yet been issued, many remain cautious and concerned about becoming “too invested” (financially, and otherwise) before further guidance regarding how the FTC and CMS will exercise their waiver authority granted under the PPACA. For instance, will new safe harbors and exceptions be created under Stark and AKS, or will ACOs need to submit for waivers on a case-by-case basis?
Last year, on October 5, 2010, the Federal Trade Commission (FTC), the Centers for Medicare & Medicaid Services (CMS), and the Office of Inspector General (OIG) of the Department of Health and Human Services (DHSS) held a 1-day workshop regarding legal issuesrelated to ACOs, namely: antitrust, physician self-referral, anti-kick-back, and civil monetary penalty laws. See the FTC’s Website and Notice of Meeting, 75 Fed Reg 57039 (September 17, 2010). Public comment was also solicited, and physicians, hospitals, health systems, consumers and “all others interested in ACOs” were invited to participate in person or by telephone.
That day-long workshop resulted in two comprehensive transcripts being posted on the FTC’s website: one for the Morning Session, and one for the Afternoon Session. These are lengthy documents, however each contains critical discussions regarding the legal issues that need to be addressed by ACOs, and therefore I highly recommend each as a “must read” for individuals involved with developing ACOs.
For a copy of the full agenda for the October 2010 Workshop, click “Continue Reading Below”.
Workshop Regarding Accountable Care Organizations, and Implications Regarding Antitrust, Physician Self-Referral, Anti-Kickback, and Civil Monetary Penalty (CMP) Laws
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Agenda 9:00-9:30: |
Opening Comments CMS Administrator, Donald M. Berwick, M.D., M.P.P. FTC Chairman, Jon Leibowitz HHS Inspector General, Daniel R. Levinson |
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9:30-10:50: 10:50 – 11:00: |
FTC Panel on Clinical Integration and ACOs. Participants will address circumstances under which collaboration among independent health care providers in an ACO permits ACO providers to engage in joint price negotiations with private payers without running the risk of engaging in illegal price fixing under the antitrust laws. Break |
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11:00 – 12:30: |
FTC Panel on Encouraging Competition among ACOs. Participants will discuss ways to encourage formation of multiple ACOs among otherwise independent providers so that competition among ACOs in any given geographic market will improve the quality and affordability of health care. |
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12:30 – 1:30: |
Lunch |
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1:30 – 2:50: 2:50 – 3:00: |
HHS Panel Participants will explore the different ways in which the Secretary may exercise waiver authority or create new exceptions and safe-harbors related to the physician self-referral law, the Anti-kickback statute and the CMP law in order to encourage the creation and development of ACOs. Break |
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3:00 – 4:30: |
HHS Listening Session Attendees of the workshop both in the auditorium and on the teleconference line will provide comments to HHS regarding the interaction between ACOs and the physician self-referral law, the Anti-kickback statute and the CMP laws. |
October 5, 2010
