Care Coordination, Clinical Integration, Group Practices, and Research: Designing Healthcare Provider Incentives

The healthcare industry continues its shift from measuring and paying for the volume of care provided to emphasizing and tying payment to the value of care provided. With this shift, healthcare provider contracts and transactions increasingly include financial incentives that are to encourage coordinated and targeted efforts toward improving measures of quality and cost. Although such financial incentives are generally considered reasonable and even necessary to achieve the socially desired changes in provider practices and behaviors, they remain fraught with potential regulatory pitfalls, even after the new compliance options introduced through the Regulatory Sprint to Coordinated Care.

In many ways, the COVID-19 public health emergency and related challenges dramatically shifted our understanding of value in healthcare delivery, and likewise the goals and targets for provider financial incentives. Work RVUs and work hours have been replaced or significantly supplemented by measures of panel size, quality, and cost effectiveness. Traditional measures of good provider citizenship, such as participation in continuing education or outreach, are being replaced or supplemented by targets for advancing or participating in clinical research or care management initiatives.

At the same time, both related and unrelated regulatory and market changes have dramatically altered the data and “rules of the road” that may be relied upon for structuring compensation and service arrangements with physicians and other providers.

Our panel will guide healthcare counsel and advisers on the emerging trends in financial incentives for physicians and other providers and the pitfalls in properly documenting, structuring, and implementing them. The panel will review the relevant changes to the Stark Law and Anti-Kickback Statute regulations, the implications for physician incentives, and the different regulatory structures under which healthcare organizations must operate in 2024 and forward.

We will review these and other key issues:

• What are the recent trends in physician incentives?
• What steps can healthcare advisers take to ensure regulatory compliance when structuring physician incentives?
• What are the implications for compliance with the Stark Law, the AKS, tax exemption and public entity laws, and other laws and regulations?