Home Profile Services Leadership Clients News Events Contact Contact
Valuation Consulting Commercial Reasonableness Commercial Payor Reimbursement-benchmarking Litigationsupport Expertwitness Financial Analysis Modeling Intermediary Services Certificate of Need ACO Valuemetrics Strategic Consulting Industry Research Services





CBO Releases Updated Scoring on American Health Care Act

On May 24, 2017, the U.S. Congressional Budget Office (CBO) released its updated analysis of the American Health Care Act (AHCA), the legislation passed by the U.S. House of Representatives to repeal and replace the Patient Protection and Affordable Care Act (ACA), a/k/a Obamacare.  The CBO's updated analysis estimated that the May 4, 2017 version of the AHCA, a revision to the earlier, March 2017 draft of the bill,  would result in approximately 23 million more uninsured individuals by 2026. This estimate is slightly less than the CBO's scoring of the original bill, which was estimated to increase the number of uninsured individuals by approximately 24 million.  While the bill estimated a significant increase in the number of uninsured persons, the CBO noted that federal spending would be reduced by $119 billion through 2026, due in part to reduced federal Medicaid expenditures.  The AHCA is now under consideration in the U.S. Senate. Upcoming issues of Health Capital Topics will feature ongoing coverage of major milestones and policy changes affecting healthcare reform, including negotiations surrounding the AHCA in the Senate and other ACA repeal and replace efforts.

On May 4, 2017, the U.S. House of Representatives voted 217 to 213 (with 20 Republicans and every Democrat in opposition) to pass the AHCA, a bill designed to repeal and replace the ACA, a/k/a Obamacare.  The May 4, 2017 version of the AHCA, which alters many of the core features of the landmark healthcare legislation passed under the Obama Administration in 2010, served as a revision to an earlier draft of the bill that was introduced, then withdrawn, in the House in March 2017.  The AHCA is now under consideration in the U.S. Senate, where both the timing of consideration, as well as the ultimate text of the bill, remain uncertain.  (Read more...) 
 
In response to the advent of value-based reimbursement (VBR), most recently through the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which reimbursement models rely on incentivizing providers to achieve better outcomes at lower cost, hospitals are increasingly seeking closer relationships with physicians. Corresponding with this growing trend toward hospital-physician alignment, and specifically toward vertical integration, there has been increased federal, state, and local regulatory oversight regarding the legal permissibility of these arrangements, most notably related to fraud and abuse laws.  The application of these fraud and abuse laws has, at times, been at odds with the goals of healthcare reform. Specifically, the discord between the objectives of fraud and abuse laws, and the objectives of VBR models such as those promulgated through MACRA, reflect a disjointed approach to healthcare reform by numerous federal agencies, including the Department of Health and Human Services (HHS), the Office of Inspector General of HHS, and the Department of Justice, whereby "the left hand doesn't know what the right hand is doing." (Read more...) 
 
On March 7, 2017, NorthShore University HealthSystem and Advocate Health Care announced their abandonment of plans to merge into one hospital system.  This decision was announced approximately fifteen months after the Federal Trade Commission (FTC) filed a complaint to enjoin the merger in December 2015.  This potential union would have created the eleventh largest not-for-profit hospital system in the U.S., comprising sixteen hospitals spanning from the north Chicago suburbs to central Illinois.  In regard to the abandoned merger plans, NorthShore CEO Mark Neaman stated, "We have determined with the Advocate Health Care leadership that the time, cost and uncertainty of pursuing any additional appeals would not be worthwhile."  Advocate CEO Jim Skogsbergh additionally explained that the two hospital systems "pursued this merger because it aligned with [Advocate's] mission and values to advance care and lower costs for patients."  (Read more...)
 
Artificial intelligence (AI) is not the first instance wherein technological innovators have deluged the healthcare delivery system with devices, processes, and other innovative ideas in an effort to decrease costs and improve value-based care. While the development of AI appears to be progressing faster now than when it was originally introduced in the 1950s,  recent efforts to implement new technology are being hindered by the current regulatory environment. As of the date of publication, no federal statutes exist that specifically govern AI - only general laws, regulations, and guidance related to scientific research, most of which, if not all, lack the term "artificial intelligence."  The U.S. Copyright Office, for example, has only stated in its guidance that it will not register or provide patents for mechanisms formed by a machine or "mere mechanical process that operates randomly or automatically without any creative input or intervention from a human author."  The term is also noticeably absent from the 21st Century Cures Act, which was passed in 2016 to "usher in a new, more industry-friendly era of drug and device regulation." (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!