Accountable Care Organizations offer physicians a collaborative, quality-based model.
Jackson LLP’s healthcare attorneys offer strategic guidance to physician participants in Accountable Care Organizations (ACOs). ACOs offer providers and practices opportunities to establish accountable care networks and clinically-integrated organizations – but they also present a complex web of legal, regulatory, and policy concerns.
ACOs are a relatively new structure, emerging with the enactment of the Affordable Care Act (ACA) in 2010. The ACA and its regulations impose several structural requirements upon ACOs, including: minimum contract duration, established quality and cost reporting structures, appropriate management structures, sufficient physician participation to meet the needs of enrolled patients, clinical processes reflecting evidence-based medicine, and compliance with specified patient-centered care markers. The ACO’s structure necessitates that the participating providers stop viewing their physician relationships as primarily contract-based and begin seeing them as fully integrated, patient-focused physician relationships.
ACO formations require consideration of countless legal implications.
ACOs are an extraordinarily complex legal undertaking, and they require an attorney to evaluate myriad legal consequences: antitrust prohibitions, Anti-Kickback Statute, corporate practice of medicine, fee-splitting prohibitions, HIPAA, Stark Law, and more. Jackson LLP’s attorneys will also evaluate the potential corporate structures and business relationships for the ACO and its participants. From there, the ACO will develop its compliance programs, physician contractual relationships, insurance relationships, and management structure.
For physicians looking to conform their practice to the increasingly quality- and value-based care standards, an ACO can be an appealing option. A physician who is considering ACO participation may also wish to consider other “new” payment models.
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