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ACA Repeal and Replace Bill Withdrawn by House Republicans

On March 24, 2017, Republican leaders in the U.S. House of Representatives withdrew the American Health Care Act (AHCA) before a scheduled vote on the bill occurred.  The bill, which sought to repeal and replace numerous provisions of the Patient Protection and Affordable Care Act (ACA) signed by former President Barack Obama in 2010, has been tabled for the foreseeable future, despite statements from Republican House leaders claiming that negotiations surrounding the AHCA have restarted.  Upcoming issues of Health Capital Topics will feature coverage of major milestones and policy changes affecting healthcare reform, including negotiations surrounding the AHCA and other ACA repeal and replace efforts.

On January 20, 2017, President Trump issued an Executive Order that directed the heads of government agencies responsible for implementing the Patient Protection and Affordable Care Act (ACA), including the Department of Health and Human Services (HHS) and the Internal Revenue Service (IRS), to lessen the economic and regulatory burdens of the ACA. Since the issuance of this order, the impacted agencies have grappled with how to implement the Executive Order, as it did not formally amend the ACA, instead focusing on the authority of these agencies regarding the continued implementation of the law.  Two agencies in particular, HHS and the IRS, have responded in ways that intend to lessen the burden of consumers with regard to the insurance marketplaces and the individual mandate, respectively. This Health Capital Topics article examines the guidance promulgated by these two agencies and consider their practical effects, as well as the likelihood of further changes to the ACA under the Trump Administration.  (Read more...) 
In December 2016 and January 2017, over 100 leading healthcare organizations sent two letters to President Donald Trump and Vice President Michael Pence lobbying the Trump Administration to continue the shift in healthcare reimbursement from volume-based to value-based payment models. The expansion of the number and scope of value-based reimbursement programs following the 2010 passage of the Patient Protection and Affordable Care Act (ACA) is in keeping with the national strategy regarding healthcare reimbursement in the landmark legislation; most notably the fourth priority established by the ACA, i.e., to "...improve Federal payment policy to emphasize quality and efficiency..." However, in light of the criticism of many in the Trump Administration regarding value-based reimbursement models, most notably Tom Price, M.D., the Secretary of the U.S. Department of Health and Human Services (HHS), many healthcare delivery organizations felt compelled to advocate for continued implementation of such payment systems, and acted by sending the above referred letters to the new administration. This Health Capital Topics article summarizes the contents of those two letters received by the Trump Administration, and discusses how this advocacy fits into the current uncertainty surrounding healthcare reform. (Read more...) 
The American Health Care Act (AHCA), bill designed to "repeal and replace the Patient Protection and Affordable Care Act [ACA]," contained little discussion related to tort reform, which, as discussed in Part One of this series, was a common theme of many of the initial "repeal and replace" proposals offered by Republican members of the House.  However, with the approval by the House Judiciary Committee of the "Protecting Access to Care Act of 2017," which seeks to implement a non-economic damages cap of $250,000 for medical malpractice actions, Congress may still act on bills related to tort reform in the coming months. As federal politicians consider tort reform, a consideration of the current medical malpractice environment may serve to place this political debate into context, including the prevalence of medical errors, the concentration of medical malpractice lawsuits within the physician population, and tort reform efforts on the state level. This Health Capital Topics article is the second installment in a three-part series examining the current state of tort reform in the U.S., and briefly discusses the present environment of medical malpractice and legislative initiatives across the U.S. addressing tort reform.  
(Read more...)
The False Claims Act (FCA) continues to grow in strength as the federal government and relators increase their use of the law to recover billions of dollars from companies that violate the Act's provisions. Developments in the application and interpretation of the FCA, particularly in regard to the issue of statistical sampling in proving damages, may significantly influence the regulatory risk to healthcare enterprises, in light of the significant volume of recoveries received by the government under this law for healthcare fraud and abuse violations.  In recent months, interpretation of the FCA influenced the outcome of two prominent healthcare fraud and abuse cases: (1) U.S. ex rel. Michaels v. Agape Senior Community (Agape), originating in the U.S. District Court for the District of South Carolina and heard by the U.S. Court of Appeals for the 4th Circuit; and, (2) U.S. ex rel. Ruckh v. Genoa Healthcare Consulting, Inc. (Genoa), in the U.S. District Court for the Middle District of Florida. The cases, both of which explored the utilization of statistical sampling in proving damages under the FCA, leave unclear the standards associated with the admissibility of expert testimony in this context. This Health Capital Topics article summarizes the Agape and Genoa cases, and discusses the role that statistical sampling may play in future FCA actions. (Read more...)
ANNOUNCING

Advanced Distance Education to Launch in 2017

The Institute for Healthcare Valuation (IHV) & Consultants' Training Institute (CTI) are pleased to announce premier healthcare valuation training through a distance education program, the Certificate of Educational Achievement (CEA) for Advanced Education in Healthcare Valuation. The program will launch in the summer of 2017 and will bridge the interdisciplinary nature of healthcare valuation to include: the Four Pillars of Healthcare (regulatory, reimbursement, competition, and technology); the market forces shaping the U.S. healthcare industry; and the valuation of healthcare enterprises, assets, and services. Legal professionals and healthcare providers, as well as those wishing to expand their scope of activities in healthcare valuation engagements and those seeking to enhance their current healthcare valuation service lines, will gain comprehensive knowledge through completing the expansive program. The program has been developed and is being presented by industry thought leaders Robert James Cimasi, MHA, ASA, MCBA, FRICS, CVA, CM&AA, Chief Executive Officer, and Todd A. Zigrang, MBA, MHA, FACHE, ASA, President of Health Capital Consultants, alongside a blockbuster faculty of healthcare subject matter experts from the legal, federal regulatory, and valuation professions.
HCC CEO Bob Cimasi Recognized as a "Pioneer of the Profession" 
under NACVA's "Industry Titans" Awards

HCC CEO Robert James Cimasi, MHA, ASA, FRICS, MCBA, CVA, CM&AA, has been
named a "Pioneer of the Profession," by the National Association of Certified Valuators and Analysts (NACVA) and Consultants Training Institute (CTI) as part of their Silver Anniversary recognition luncheon of valuation "Industry Titans," which distinguishes those whom have had the greatest impact on the profession.  Mr. Cimasi joins valuation profession luminaries, including: Dr. Shannon P. Pratt, Chris Mercer, James R. Hitchner, Roger J. Grabowski, Richard Wise, Jay E. Fishman, Nancy Fannon, Honorable Judge David Laro, Howard Lewis, and Mel H. Abraham, along with fourteen others, in receiving this honor. Congratulations to Bob Cimasi and his fellow "Pioneer of the Profession" honorees from the HCC Team and Topics Staff!