Health Care

Hospital bankruptcies are on the rise, and rural hospitals are no exception. About 20% of rural hospitals are considered to be at risk of closure nationwide, and the majority of these hospitals are considered essential to their communities. In light of these trends, this webinar will provide ABI members an overview of the unique issues faced by small rural hospital designated as “critical access hospitals” (“CAHs”) by the Centers for Medicare and Medicaid Services. Established by the Balanced Budget Act of 1997, the CAH designation allows eligible rural hospitals to receive reimbursement from Medicare (and state Medicaid programs) based on 101% of allowable costs rather than the traditional fee-for-service model. In order to receive the CAH designation, a hospital must be at least 35 miles from another hospital and meet at least the following criteria: (1) have 25 or fewer inpatient acute beds; (2) maintain an average length of stay of less than 96 hours for acute beds and (3) provide 24/7 emergency services. Despite what should be a favorable reimbursement model, the nation’s approximately 1,350 CAHs are plagued with a variety of regulatory and socioeconomic hurdles hampering their profitability. These include shrinking federal and state budgets, physician shortages, the high cost of providing care to under- and uninsured patients, certain physician costs that are not reimbursed on a cost-plus basis, and difficulty repaying overpayments by the Medicare and Medicaid programs. In a lively forum, this panel will focus on: 1. Debt restructuring challenges faced by CAHs due to their narrow margins and cost-based reimbursement model; 2. Alternative solutions to cash flow for CAHs through expansion of medical services, large group physician employment agreements, telemedicine and operational efficiencies; 3. Legal expansion programs in a CAH environment and illegal schemes perpetrated by bad actors who take expansion too far; 4. The roadmap to reorganization for CAHs who find themselves amid allegations of violations of the False Claims Act, Stark Law and Anti-Kickback federal and state laws and in the snarls of a healthcare fraud investigation with either CMS, Medicaid, OIG or commercial payers’ SIU departments; and 5. How to overcome the overpayment liability dilemma. Speakers Carol L. Fox GlassRatner Advisory & Capital Group LLC Elizabeth A. Green BakerHostetler Andrew Helman Murray Plumb & Murray Frank P. Terzo Nelson Mullins Riley & Scarborough LLP View Materials

Hosted by the Business Reorganization, Health Care and Secured Credit Committees The panel will discuss the risk of administratively insolvent health care cases, the issues that create such risk, the impact on the various constituencies, and potential ways to mitigate those risks, including the use of cash collateral and availability of post-petition financing. The panel will also address one specific issue that creates the risk of administratively insolvent health care cases: the exercise of the so-called Strumpf administrative freeze by CMS on Medicare reimbursements, which can cut off the lifeline of many health care businesses.

They just keep filing! This panel will discuss strategies and issues for dealing with the struggling health care industry.

Most health care businesses rely on Medicare, Medicaid and insurance company monies. As a result, understanding the reimbursement system is key to a business’s success or failure. Business leaders on the provider and managed-care side will discuss the rates and pressures on health care businesses, including in insurance company mergers/renegotiations of contracts, and the impact of hospital readmissions, fraud and ACOs. Other panelists will provide a detailed overview of the legal framework, structure and pitfalls of the reimbursement system, including regulatory dos and don’ts and how to keep the money flowing during a restructuring (whether in or outside of bankruptcy).

How do investors and lenders view the health care services industry? Investors will outline criteria for investing in deals, identify key trends and issues, and provide various return characteristics regarding their investments by type of investment. The lenders will outline their views of risk within the various sectors, outline their views of the current state of the market, provide general terms regarding their specific products, and provide a general overview of how their loans are performing. There also will be a focus on some of the more challenging sectors of the industry, particularly hospitals, senior housing and post-acute care. Finally, this panel will highlight the legal challenges in structuring a health care loan, how to attempt to isolate liabilities, and how to recover your money when you need to take legal action on account of defaults, including navigating complex regulations when dealing with patients, records and medical waste, as well as the complexities of a restructuring.

This panel of experts leave conference attendees with key takeaways that will help them know where to find their next opportunities. These experts highlight the financial and legal issues facing the distressed sectors of the industry that you need to know as you work through the restructuring issues facing these sectors.

With Amazon, Walmart and others entering the health care market and partnering with established players, there will be winners and losers as health care businesses navigate the changing delivery of care — from the minute clinics to telemedicine to concierge medicine to whatever might be coming next. This panel will provide an overview of the changes in the delivery of health care, including the legal implications of those changes such as privacy concerns, security breaches, antitrust implications and other legal challenges as the law tries to catch up with innovation.

CEOs share their insights on the challenges facing the industry, the new innovations that will transform the industry, and how health care policy is expected to change, when it will change, what needs to change, and how politics plays into all of this!

What are critical-access hospitals, and why are they important? This panel will discuss alternative solutions to producing additional cash flow for failing hospitals, which need to be closely scrutinized by health care professionals familiar with licensing, reimbursement, anti-kickbacks and patient-brokering limitations. The panel will also cover violations of the False Claims Act, Stark Law and Anti-Kickback Statute, as well as state law cases on patient-brokering and the questioning of medical necessity, clinical laboratory outreach programs, physician employment arrangements involving telemedicine, prescription programs and compounding, criminal statutes and DOJ/state regulator issues, how to reorganize legally, dealing with CMS (Medicare/Medicaid), nongovernmental and third-party commercial payers during a restructuring, and general rules on pass-through billing for outreach programs.