Deputy Governor Cristal Thomas to Present on the Illinois 1115 Waiver and Related Healthcare Topics

Event Summary

Deputy Governor Cristal Thomas will lead this complimentary seminar on the Illinois 1115 Waiver and related healthcare topics. She will discuss the implications of the waiver on delivery and reimbursement specific to hospitals, as well as the impact on other Medicaid providers. She will also cover the submission, approval and implementation processes. Taft attorneys Cathy Dunlay, Sara Rorer and Greg Bee will present on related hospital integration issues.

Schedule:

7:30-8:00 a.m.
Registration, breakfast & networking

8:00-8:05 a.m.
Welcome – Barry Maram and Judy Sherwin, Taft Law

8:05-8:45 a.m.
The Illinois Waiver Proposal – Cristal Thomas, Deputy Governor of the State of Illinois

8:45-9:15 a.m.
The Shifting Paradigm of Hospital/Physician Relationships – Cathy Dunlay, Taft Law

This presentation will focus on the impact of the shift from volume to value on hospital/physician relationships, including expansion of employed and co-management relationships and changing physician compensation models. The tension between the new value paradigm and health care laws restricting referrals (i.e., Stark and Anti-Kickback) and prohibiting inducements to limit care (i.e., civil monetary penalty laws) will be discussed, together with approaches to move forward and form the needed relationships while addressing the legal limitations.

9:15-9:45 a.m.
Recent Trends in Hospital-Physician Employment and Other Arrangements: What Hospitals Need to Know About the Physician’s Perspective – Sara Rorer, Taft Law

This presentation will focus on some of the key motivators and deal-breaking issues (both economic and non-economic) for physicians that hospitals should keep in mind when negotiating such contractual arrangements, including, but not limited to, productivity and quality compensation incentives, autonomy and other physician group governance issues, buy-backs and exit strategies, restrictive covenants and non-physician staff issues. We will also address physician practice leasing as an intermediary or alternative to acquisition of physician practices. Finally, will discuss how the “corporate practice of medicine” doctrine may impact these hospital-physician arrangements.

9:45-10:15 a.m.
Peer Review in an Employed Physician World – Greg Bee, Taft Law

This presentation will cover the shift from the traditional independent medical staff model to an employed-physician model, and the impact that this new model has on the hospital’s peer review process. Traditionally, the hospital medical staff has overseen physician peer review, and with a properly organized and conducted peer review process has come certain immunity and confidentiality protections established under state and federal law. By contrast, discipline of employees has typically been the province of an employer’s (including a hospital’s) human resources department. The state and federal peer review immunity and confidentiality protections do not typically reach into HR departments. We will discuss the tension between the peer review and HR functions for hospital and employed physicians, and we will suggest ways to maintain the integrity of the physician peer review process for employed physicians while still permitting some sharing of information between hospital medical staffs and hospital (or hospital affiliate) employers.

10:15 – 10:30 a.m.
Question & Answer