Clinical Integration and ACO Alert 

News and Information from Broad and Cassel's Health Law Practice Group

November 2013
Volume 3, Issue 6
Practice Group Update
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 Upcoming Speaking Engagements

Gabriel Imperato:
12/2-12/5: HCCA Basic Compliance Academy, San Diego
1/20-1/23: HCCA Basic Compliance Academy, New York
Featured Authors

Mike Segal headshot  

Mike Segal


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 Stephen Siegel  

 Stephen Siegel

Of Counsel

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Christine Burke Worthen

Of Counsel

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Joshua Boxer

Senior Counsel

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Heather Miller (New)  

Heather S. Miller

Senior Counsel

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Fred Segal  
Fred Segal

To our clients and friends:


Every day we hear about the bungled effort of the Obama Administration in the Health Exchange roll-out, which is clearly a fact.   The computer and political problems continue.   


What I want to make clear, however, is that the evolution of the "triple aim," the provision of better health care to a defined patient population, at a lower cost, is going to continue notwithstanding the problems with ACA and the ongoing political hassles.   As we have said many times before, THE TRAIN HAS LEFT THE STATION!  Those dreaming of the "good old days" need to forget it - it's not going to happen.


We think that payors and providers alike should be looking to place themselves in the best position possible to be a meaningful party in the necessary relationships to accomplish the "triple aim."  This is a long term process, one of which will take many years but clearly, as Bob Dylan wrote a long time ago, "the times they are a-changing!"


Mike Segal

Chair, Health Law Practice Group

Broad and Cassel


By: Stephen Siegel


An ACO might be a HIPAA Covered Entity, a Business Associate, or both. Unlike the waivers to the Federal health care programs' Kickback Prohibition and the so-called Stark Law for arrangements that further the MSSP's "triple aim", neither the OIG, CMS, nor the HHS Office of Civil Rights has granted any relief for ACOs from the requirements of HIPAA-HITECH. ACOs, therefore, need to take care to ensure that they and their participating providers exchange protected health information in compliance with these obligations.

Please click here to continue reading.

Integrating Post-Acute Care Providers

By: Christine Burke Worthen


While there has been a lot of focus on ACO's and care coordination in the primary care and hospital settings since the enactment of the Affordable Care Act, there has been a greater focus more recently on the role of post-acute care providers in the ACO model. From contracted relationships to informal "partnerships" to full integration, ACO's are taking note of the opportunity for cost savings by expanding their efforts to the post-acute care setting.  Hospital systems that own post-acute care organizations are doing away with the traditional fragmented care approach and are including the post-acute providers in ACO operations discussions.   As a result, new roles are emerging, such as the new "transitions of care" coordinator. Plus, care delivery in the post-acute setting is being redesigned to support a new care delivery model, and data analytics capabilities are being expanded to incorporate the post-acute setting.


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Dartmouth Releases Study on Market and Demographic Factors Effecting Forming ACOs

 By: Joshua Boxer


This past October, the Dartmouth Institute for Health Policy and Clinical Practice published the findings of its study entitled, "Accountable Care Organizations in the United States: Market and Demographic Factors Associated with Formation," in the Journal for Health Service Research. The study sought to determine the numbers, demographics, and characteristics associated with the formation of ACOs in the United States. The study found that the formation of ACOs is driven by local demographics and market forces, with ACOs more likely to be formed in locations where it is easier to meet the relevant cost and quality benchmarks.


Click here for the full article.

Some States See Surprisingly Good Enrollment in the Obamacare Healthcare Exchange Plans

By: Fred Segal


The consensus opinion by just about every expert, journalist, and even the White House itself, is that the Government did a poor job in its execution of rollout of the Healthcare Exchanges under the Patient Protection and Affordable Care Act (ACA).  The federal website that hosts the exchanges for many states constantly had connection issues, and many people could not even log on.  In the first month,  Katherine Sebelius, the Secretary of the Department of Health and Human Services, announced that only 106,185 individuals have enrolled in the Healthcare Exchanges. This enrollment number is way below the goal set by HHS before commencement of the rollout.


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 About Us
With more than 20 attorneys and a full complement of support staff, Broad and Cassel's Health Law Practice Group is intimately aware of the complex issues faced by health care providers, suppliers and consumers. 

Fundamental changes to the nation's health care delivery system are occurring at an accelerated rate, requiring those in the industry to establish and refine their practices and policies to comply with new regulations. The attorneys of our Health Law Practice Group are prepared to discuss these changes and the potential impact they will have on health care providers of all types.