Value Based Enterprises

From Group Practice with Neal Goldstein · 27:08

Show by Neal Goldstein

More than five years and 400+ pages of federal regulations later, have Value-Based Enterprises actually helped a single independent group practice? When CMS and the OIG launched the Regulatory Sprint to Coordinated Care, the promise was streamlined compliance and lower healthcare costs. Instead, healthcare attorney Neal Goldstein argues, regulators delivered hundreds of pages of abstract theory on Value-Based Enterprises (VBEs) while ignoring the real, everyday regulatory roadblocks facing independent physicians. Using the orthopedic patient journey as a blueprint, this breakdown is for physician group owners, orthopedic surgeons, and healthcare executives who want practical Stark Law and Anti-Kickback Statute reform that actually works in the real world. What you will learn: ● Why the 2020 CMS and OIG Value-Based Enterprise exceptions look great in theory but lack concrete, workable examples for independent practices. ● How CMS treats a $35 digital X-ray the same as an advanced MRI or CT scan under Stark Law, and why crediting physicians for the technical component would reduce unnecessary advanced imaging. ● Why the 1991 Anti-Kickback Statute ASC Safe Harbor (and its one-third tests) locks out large group practices from owning surgery centers within a safe harbor. ● What OIG Advisory Opinion 08-08 reveals about how large physician groups currently navigate ambulatory surgery center ownership risk. The difference between passive referrals (like labs and imaging) and personally performed surgeries, and why surgeons cannot “overutilize” their own OR time. ● How allowing surgeons to earn credit for ASC facility fees minus overhead costs would shift more procedures out of high-cost hospitals. ● Why Stark Law’s “same building” requirement blocks orthopedic groups from owning home health agencies, despite allowing in-office PT, OT, and DME. ● Why integrating home health directly into a physician group practice using shared EHRs and supervision is the best way to curb home health fraud and reduce readmissions. Timestamps: 00:00 – Why Value-Based Enterprises (VBEs) Are Overcomplicated 01:04 – The 2018 Regulatory Sprint to Coordinated Care Explained 04:02 – The 3 Stark Law Value-Based Arrangement Exceptions 08:13 – The Orthopedic Patient Journey: 3 Targeted Stark and AKS Fixes 09:42 – Fix 1: Digital X-Rays and Stark Law Technical Component Rules 13:57 – Fix 2: ASC Safe Harbor Limits and OIG Advisory Opinion 08-08 17:30 – Why Surgeons Cannot Overutilize Personally Performed ASC Cases 21:00 – Fix 3: Home Health Ownership and Stark’s Same Building Rule 24:31 – A Blueprint for Targeted Stark Law and Anti-Kickback Reform About the Host: Neal Goldstein is a healthcare corporate attorney and the host of Group Practice, where he helps physician owners, medical group executives, and healthcare leaders navigate the business and legal realities of independent medicine. He specializes in physician group governance, mergers and acquisitions, regulatory compliance, and strategic practice growth. Website: https://www.pfs-law.com/ Website: https://www.goldsteingrouppractice.com/ Website: https://nealtgoldstein.com/ LinkedIn: https://www.linkedin.com/in/neal-t-goldstein-841aa652/ New episodes every Tuesday, subscribe so you never miss one. Spotify | Apple Podcasts | YouTube Disclaimer: The information provided in this video is for educational and informational purposes only and does not constitute formal legal advice or establish an attorney-client relationship. #HealthcareLaw #ValueBasedCare #StarkLaw #AntiKickbackStatute #GroupPractice #OrthopedicSurgery #AmbulatorySurgeryCenter #PhysicianLeadership #ValueBasedEnterprise #CMSRegulations

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