Legal and Operational Issues for Academic Medical Centers

1
Legal and Operational Issues for Academic Medical
Centers

• Pay for Performance

William D. Darling, Esq. Strasburger Price,
LLP 600 Congress Avenue, Suite 1600 Austin, Texas
78701 [phone] bill.darling_at_strasburger.com
2
Legal and Operational Issues for Academic Medical
Centers

• AMCs must navigate regulatory and operational
  challenges in structuring their participation in
  P4P.
• This presentation will review these regulatory
  and operational challenges.

3
Legal and Operational Issues for Academic Medical
Centers

• Navigating these regulatory and operational
  challenges is as important to the success of a
  P4P system as the more recognizable P4P issues
  such as
• Adoption of valid clinical indicators
• Development of scorecards
• Coordination of episodes of care
• Reimbursement methodologies

4
ACADEMIC MEDICAL CENTERORGANIZATIONAL
SCHEMESingle Entity AMC
AMC Organization
EMPLOYED PHYSICIAN SERVICES DEPARTMENTS Radiolo
gy Surgery Pediatrics Orthopedic
Surgery Urology Primary Care Surgery Cardiology
HOSPITAL SERVICES IN PATIENT OUT PATIENT
Outside Payors
AMC- Owned HMO
Payor
Payor
Contract
Contract
5
ACADEMIC MEDICAL CENTERORGANIZATIONAL
SCHEMEJoint Contracting
Foundation
Faculty Practice Plan Radiology Surgery Pediatrics
Orthopedic Surgery Urology Family Practice
Academic Hospital In Patient Out Patient
Medical School Paid Physician Faculty
Affiliation
Affiliation
Agreement
Agreement
Payor
Payor
Imaging Center
AMC Sponsored Contracting Organization
Payors
6
Legal and Operational Issues for Academic Medical
Centers

• Pay for Performance

William D. Darling, Esq. Strasburger Price,
LLP 600 Congress Avenue, Suite 1600 Austin, Texas
78701 [phone] bill.darling_at_strasburger.com