• ACO snatching docs from rival

    In this morning’s Boston Globe, Robert Weisman reports that the Beth Israel Deaconess Harvard Hospital lost 150 physicians in a defection to an upstart venture capital funded rival, Steward Health Care:

    But a law firm hired by Beth Israel suggested that some incentives Steward offered Whittier violate federal and state “anti-kickback’’ statutes. Those laws prohibit paying for business that can be billed to government health insurers. A spokesman for Steward, a fast-growing, for-profit health care company, said its contract with Whittier is legal.

    My money is on Steward on this legal issue:

    • The feds are showing growing fraud & abuse law flexibilities for ACO models, which is where Steward is heading
    • As we’ve said here before, consolidation is one of the effects of the ACO model
    • Notice no mention of Stark II, the more problematic statute in this area
    • Hardly anyone with interesting deals meets all of the anti-kickback statute safe harbors; that means nothing by itself
    • The underlying contract is the BCBS shared savings contract, the current darling of health care reimbursement wonks
    • If Steward wants additional assurance, they can ask for an OIG Opnion
    • Steward’s outside legal team on these issues is excellent (my former firm)

    Prior TIE coverage:  Mass. doctors want to use ACO rules to violate antitrust laws; other ACO TIE posts here.

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    • Kevin
      Thanks for this article, although it overlaps as much with the other posts here, just as much as you yours (legal). It deserves a read by all.

      Its fascinating how Mass, in addition to its reforms and universal coverage, is the canary in the coalmine for everything else in play–not just access, but the whole shooting gallery (except in fast forward).

      As I read the piece, the issue of consolidation, scale, power concentration, etc., all bubbled up, and its easy to see how as much as a microcosm the IPA and Steward dynamic is, these are the future battles for the other 49.

      What is more challenging, is you cant envision who is correct, or what is best re: public interest. Correspondingly, as this plays out nationally, it appears that no cohesive strategy to make sense of who wins and loses will spring forth, and will be right back to point zero on “best path forward.”. It all so ambiguous and local.

      The rear view mirror will be the only compass to render judgment, unfortunately .

      Brad