Outpatient Surgery Magazine

Why Can't He Eat or Drink After Midnight? - March 2016 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 147 of 160

in competition from joint negotiations with employers, and that estab- lishing a new legal entity will not insulate providers from price-fixing claims. On the other hand, connecting clinical and financial integration efforts with direct contracting can, under some circumstances, permit competitors to negotiate jointly. As always, steer clear of anti-kickback violations. Research whether your direct contracting program's relation- ships could be seen as influencing the referrals of Medicare and other federal payer beneficiaries, and whether your state's laws can impact the way your providers work together. How will your program fit with the benefit plan designs of prospective employer partners? Packaging your services in a way that is attractive to the employ- ers you're targeting often requires some understanding of benefit plan design and the federal Employee Retirement Income Security Act (ERISA) law. In recent years, many employers have been adopting ben- efit plans that involve high deductibles and health savings accounts. In this context, direct contracts should be structured to avoid appearing as though they're creating a standalone benefit (which would raise compliance issues with respect to the Affordable Care Act's market reform requirements) or "first dollar" benefits, which could destroy health savings account eligibility. How will you address professional liability? Collaborations among providers, such as those seen in the deliv- ery of bundled care, should be accompanied by clear contractual requirements that each provider maintain appropriate levels of profes- sional liability insurance. Indemnification agreements, which limit the responsibility of each participant for their own acts and omissions, can reassure employers who harbor concerns that they'll be blamed for steering employees to a provider in the event of a malpractice 4 5 Legal Update LU 1 4 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A R C H 2 0 1 6

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