Accountable Care Organizations
Squire Sanders helps clients navigate the most critical issues related to the accountable care organization (ACO) provisions included in the 2010 US healthcare reform legislation. Affecting physicians, hospitals and patients, the law and its accompanying regulations and other regulatory guidance define a new model for the delivery of, and payment for, healthcare services in which providers work together to improve patient care, and fees are based on quality, outcomes and efficiency of service.
We represent clients on important ACO formation projects, advise them on ACO-related health insurance issues and present on ACO topics as part of national panels. In addition, our partner Peter A. Pavarini edited the American Health Lawyers Association’s
Handbook on Accountable Care Organizations.
We focus on transforming traditional hospital-physician relationships into ones that will achieve the objectives of accountable care – for example, aligning the interests of these two groups through clinical co-management and other alternative models.
Our lawyers have expertise in:
- ACO development including eligibility, start-up costs and transforming existing models into ACOs
- ACO ownership v. partnerships
- Antitrust concerns
- Beneficiary attribution
- Downside risk sharing
- Governance/management
- Hospital-physician integration
- Patient-centered medical homes
- Physician compensation
- Quality and performance measures
- Regulatory compliance/legal waivers
- Related regulations from the US Federal Trade Commission, Internal Revenue Service, Department of Justice and Office of Inspector General
- Shared savings programs and other payment methodologies
- Tax-exempt status
We also offer comprehensive counsel on related technology issues. For instance, to qualify for shared savings under the ACO program, providers must be able to demonstrate improved quality and efficiency by using electronic prescribing, electronic health records and other digital data capture technologies. We have extensive experience helping clients address the legal intricacies involved in adopting and implementing such technologies and can counsel organizations on how health information exchange can be leveraged to facilitate hospital alignment with physicians and pave the way for ACOs in the post-reform environment.