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April 20, 2011

Today’s issue is brought to you by AIS's Report on Medicare Compliance, the nation's leading source of news and strategic information on Medicare compliance, Stark and other big-dollar issues of concern to health care compliance officers.

Today's Featured Story

Co-Management Is a Hot New Trend in Physician Ventures, But Beware Stark Risks
Reprinted from Report on Medicare Compliance

Hospitals are jumping all over co-management agreements, which allow them to pay physicians to run a department and improve its quality and efficiency. With CMS effectively killing under arrangements through Stark regulations and some physicians balking at hospital employment, co-management opens a new door to physician-hospital alignment. Because money changes hands, however, hospitals entering into these arrangements need to navigate a fraud-and-abuse minefield .... Read Full Story


From the AIS Blogs

Another PBM Enters Medical Benefit Management Arena

CVS Caremark Corp. unveiled a new service today that will allow the PBM to manage the medical benefit, rather than solely the pharmacy benefit. Its press release claims that “the offering is the first of its kind to provide a comprehensive management solution for the buy-and-bill drug model currently used by physicians.”... Read more


Quote of the Day

“I think the most important question that we have here is how aggressively CMS allows [Accountable Care Organizations] to use the tools traditionally used by managed care: utilization management, cost control. Everybody focuses on reducing costs without anything controversial, but at the end of the day, they have to do this …by aggressively managing patients…and the question is the amount of flexibility [ACOs will have].”

— Dan Mendelson, CEO of Avalere Health, told AIS’s Health Reform Week.

Click here to read the AIS's HEALTH REFORM WEEK article in which this quote appeared. (Free for HRW subscribers; $17 for non-subscribers).


Today's Datapoint

$1 billion…could be gained by AARP over the next 10 years as a result of the AARP-supported health reform law that could drive a large migration of seniors to Medigap plans, of which AARP is a leading provider, according to a new report by three GOP members of the House Ways and Means Committee.



Today from Washington

People on the Move

Scott & White Healthcare promoted Robert W. Pryor, M.D., to president and CEO. He succeeds Alfred B. Knight, M.D., who was named president of the Scott & White Healthcare Foundation. Pryor was chief medical officer and chief operating officer....Pinstripe Healthcare appointed Kristen Wright director of marketing. Wright was vice president of marketing at Provade.


Today's Featured Health Business Job Opening

Confidential Managed Healthcare Services Company
Director, Internal Audit
Metro N.Y./N.J. Area

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Upcoming Webinars

Setting Out-of-Network UCR Rates: Evaluating FAIR Health’s New Benchmark Data and Other Alternatives for Insurers and Employers
Thursday, April 21, 2011

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New ACO Regulations: Discover the Opportunities and Pitfalls Ahead
Thursday, May 5, 2011

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Medicare Advantage Marketing for 2012: Steps to Take Now to Succeed Amid Reform-Driven Changes
Tuesday, May 10, 2011

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Payer Strategies to Manage High-Cost Specialty Drugs That Will Hit the Market Soon
Thursday, May 12, 2011

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Medical Loss Ratio Regs: What 2010 Data Suggest About Potentially Huge Rebates in 2011
Thursday, June 23, 2011

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