24th PBI Health Law Institute - Gainsharing and Clinical Integration: The Emerging Role of Hospital Associations and Other Hospital Partners in Navigating Legal Issues in Hospital Quality Improvement and Cost Reduction Arrangements

John Washlick, Shareholder in the firm's Healthcare section, will moderate a panel at this year's PBI Health Law Institute. The panel will discuss "Gainsharing and Clinical Integration: The Emerging Role of Hospital Associations and Other Hospital Partners in Navigating Legal Issues in Hospital Quality Improvement and Cost Reduction Arrangements."

As healthcare payment practices continue to transition to value-based models, hospitals face increasing pressure to both decrease costs and increase the quality of care they offer to patients. Achievement of such value goals generally requires hospital engagement of and alignment with staff physicians, often with financial incentives intended to ensure that the physicians are willing to lead or otherwise commit to the requisite collaboration and behavior changes. Unfortunately, the financial incentives are a common stumbling block for successful arrangements, since laws that govern payments and relationships between and among providers have been slow to evolve from the fee-for-service era, and as a result, pose significant challenges for those seeking to implement innovative but legally-compliant hospital-physician incentive arrangements, including gainsharing and clinical integration incentives.

The panel will discuss the ways in which local hospital associations and other hospital partners have been successfully assisting hospitals and their physician partners to identify and manage the legal and operational challenges to gainsharing, clinical integration and other incentive strategies. Topics will include model programs for bringing hospitals and physicians in alignment in a legally compliant way, and several recent state and Federal regulatory developments that may influence the future form and expansion of such model programs.