Many healthcare providers have openly voiced their criticisms and problems with accountable care organizations, but the model is also bringing on significant challenges for lawyers, according to an article in the National Law Journal.
Lawyers complain the new measure of market share, "primary service area," will be difficult and expensive to devise. Christi Braun, a partner from Washington, D.C.-based Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, said ACO participants will have to search, zip code by zip code, to determine where patients come from and how much revenue they generate. One of Ms. Braun's clients has already spent $50,000 on economists and legal fees in the ACO effort and is "not even halfway there," according to the report.
Legal experts also say ACOs are prompting the Department of Justice and Federal Trade Commission to take on new roles. If the agencies find that the ACO's formation would be anti-competitive, they'll tell CMS, which will then refuse to let it participate in the shared savings plan. There is no appeal.
Hogan Lovells Washington partner Robert Leibenluft, said this is unprecedented. "It's an unusual scenario — an agency having mandatory review prior to allowing participation in another government program," he said in the report. The arrangement turns the FTC and DOJ into antitrust regulators rather than law enforcers, he said in the report.
Read the National Law Journal article on the legal problems with ACOs.
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Lawyers complain the new measure of market share, "primary service area," will be difficult and expensive to devise. Christi Braun, a partner from Washington, D.C.-based Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, said ACO participants will have to search, zip code by zip code, to determine where patients come from and how much revenue they generate. One of Ms. Braun's clients has already spent $50,000 on economists and legal fees in the ACO effort and is "not even halfway there," according to the report.
Legal experts also say ACOs are prompting the Department of Justice and Federal Trade Commission to take on new roles. If the agencies find that the ACO's formation would be anti-competitive, they'll tell CMS, which will then refuse to let it participate in the shared savings plan. There is no appeal.
Hogan Lovells Washington partner Robert Leibenluft, said this is unprecedented. "It's an unusual scenario — an agency having mandatory review prior to allowing participation in another government program," he said in the report. The arrangement turns the FTC and DOJ into antitrust regulators rather than law enforcers, he said in the report.
Read the National Law Journal article on the legal problems with ACOs.
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