Events Detail

The two morning sessions will be devoted to exploring antitrust issues through moderated panel discussions.

At the first session, the panelists will address circumstances under which collaboration among independent health care providers in an ACO (not including a merger), permits ACO providers to engage in joint price negotiations with private payers without running the risk of engaging in illegal price fixing under the antitrust laws.  In particular, the panel will address the indicia of clinical integration sufficient to indicate that an ACO is likely to enable participating providers to improve the quality of their health care services and whether joint price negotiation is reasonably necessary to achieve these efficiencies.   The panel also will address options for dealing with Medicare ACOs that fail to achieve CMS-required quality performance standards and that, therefore, might no longer be eligible for Medicare Shared Savings Program payments under section 3022 of the Affordable Care Act.

At the second morning session, the panelists will explore ways to encourage formation of multiple ACOs among otherwise independent providers so that competition among ACOs in any given geographic market the will drive improved quality and affordability of health care.  For example panelists will explore:  (1) the analysis of arrangements where providers or facilities are exclusive, or non-exclusive, to an ACO; (2) the impact, if any, of risk-based contracting (for example, global payments and/or capitated rates) on market power assessments; (3) ways to assess whether formation of an ACO among independent providers may allow the ACO to increase price and reduce the quality of care; and (4) the financial, utilization, outcome, and patient experience data necessary to monitor and measure the impact of an ACO on prices and quality in the relevant markets.

The afternoon will consist of two separate sessions regarding how ACOs will interact with the physician self-referral prohibition, the anti-kickback statute, and the CMP law in order to better inform CMS and OIG (HHS Agencies) decision-making regarding the application of these laws to ACOs.  The first session will be a moderated panel discussion of industry stakeholders, including representatives of providers, suppliers, and health policy experts who will focus on the discussion topics listed below.

During the second session, a listening session, there will be an opportunity for other attendees to provide brief comments on the same topics either in person or via the teleconference, as time permits.  An agenda for the moderated panel discussions and the listening session will be released at a later time.