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Care Coordination Attorneys for Accountable Care Organizations

Legal support for formation, understanding and protection of shared savings programs

As most health care providers and institutions are aware, the Affordable Care Act (ACA) contained numerous changes to the delivery of health care in the United States. One of the changes — and a potentially lucrative one — included the creation of Accountable Care Organizations (ACOs) that restructure the delivery and payment of health care services. At Buttaci Leardi & Werner, LLC, we handle all aspects of health care law for providers and entities throughout New York and New Jersey and across the country, including creation, formation and compliance for ACOs and other shared savings programs permitted under the ACA and Centers for Medicare and Medicaid Services (CMS) rules.

Why affordable care organizations and other shared savings programs?

The goal of the ACA’s acknowledgment and encouragement of ACOs and other programs is threefold. The CMS is seeking to provide better care for individuals, better health for populations, and lower growth in Medicare Part A and Part B expenditures. These reductions in costs and improvements in care can be applied to private insurers as well. The benefits for providers and health care entities include:

  • Allows eligibility for Medicare bonuses for appropriate, efficient, high-quality provision of health care services
  • Provides potential for waivers of self-referral rules, including the Stark Law, the federal anti-kickback statute and specific civil monetary penalties, as well as antitrust laws
  • Fosters and incentivizes coordination of care among various providers
  • Increases the importance of primary care disease management
  • Adds incentives to increase value for patients, instead of volume of patients, while distributing shared savings based on total per-capita costs
  • Creates additional value-added benefits for patients who receive services from participating ACOs without forcing them to lock in

Challenges facing providers who wish to set up an ACO

Buttaci Leardi & Werner can assist health care providers and entities with surmounting the challenges they may face in becoming an ACO or reviewing other shared service programs. In exchange for the benefits, including increased revenue and waivers from certain regulations and laws, practitioners must be aware of requirements, including:

  • Responsibility for the quality and cost of services and the overall care of patients
  • Mandatory participation periods
  • Formal legal structure, either as an LLC or professional corporation that permits distribution of costs and savings
  • Defined processes and procedures to report compliance with the ACO rules and coordinate care
  • An appropriate legal, compliance and management structure

Regardless of these challenges, ACOs and other shared savings programs are exciting new structures — but as with any change that can bring risks, the legal, regulatory and practical issues need to be addressed as well.

Contact us for more information

Contact Buttaci Leardi & Werner, LLC to learn more about our Accountable Care Organization legal solutions online or call us at 609.297.5942.