Health Care

This panel will discuss and summarize the challenges the US is facing in the behavioral market industry. Some topics will include addiction, mental health and special focus will be opioid crisis. The panel will break down the why there is an epidemic and what providers are doing in order to address this national crisis. Finally, the panel will discuss the Opioid crisis and discuss what led up to the recent chapter 11 filings.

Hear first-hand experience on who to survive a cyberattack, one of the many challenges facing healthcare providers today.

Consumers are utilizing retail clinics, urgent care centers, ambulatory surgery centers, concierge services and freestanding ERs to get medical care when and where they want it. The healthcare marketplace is forcing providers to rethink their business models beyond the four walls of traditional healthcare facilities. The new reality is that healthcare is taking on a consumer-centric, technology-enabled retail model, in the name of improving outcomes and lowering costs. This panel will explore how to create a Consumer Brand Experience in today's evolving healthcare marketplace. Every aspect of your organization from your stories, your online presence, mobile solutions, services and physical environment, should be an extension of your brand and what you do remarkably well. For healthcare providers, a well-defined Consumer Brand Experience means bringing your brand promise to life consistently, across every location where you market and provide services to your consumers.

The US healthcare system is consolidating at an increasing pace. Healthcare systems tout the benefits of consolidation in the form of cost savings and other operational efficiencies. But consolidation also has its costs: independent providers are being disrupted by larger systems, the larger systems themselves face higher risks, and the consumer may not always benefit. This panel will explore the pros and cons of consolidation from the perspective of consolidated systems themselves, providers that choose to remain independent, and the healthcare consumer.

This session will focus on the views of patient care ombudsmen (PCOs) on the quality-of-care issues they routinely confront in chapter 11 cases; how debtor, secured lender and committee professionals react to either support or suppress the findings made by health care experts; in-depth analysis of what constitutes the proper protocol to evaluate quality of care; the differences in the approaches made to the PCO role by a doctor, nurse and/or health care administrator; whether PCOs universally should be doctors, nurses or health care administrators and not lawyers posing as health care professionals; the obligations of PCOs to tell quality-of-care stories without concern for the potential economic impact on an exit strategy in the bankruptcy (i.e., sale, potential loss of license, etc.); the impact of transfer trauma on a change of control arising from a potential sale of the health care business; how the PCO is differentiated from a state long-term-care ombudsman, Medicare and Medicaid surveyors; and the PCO’s role as patient advocate in bankruptcy cases.

Experienced practitioners are typically able to litigate the issues that arise in most chapter 11 cases in a similar manner, regardless of the industry of a particular debtor. In the health care context, however, the identities of the litigants are often different (government agencies, patient care ombudsmen, etc.), and more importantly, those litigants’ respective motivations may be vastly different than in a "typical" chapter 11 case. Economic considerations, the driver of most chapter 11 outcomes, are often superseded in a health care case by a party’s perceived public policy or reputational concerns. This panel will discuss these differences and provide practical suggestions, based on their extensive experience, as to how attorneys and financial advisors can navigate these issues and reach a successful outcome for all stakeholders.

There have been a number of recent bankruptcy filings by large and high profile healthcare providers, such as the filings of Verity Health System of California, Inc., in Los Angeles (the second largest hospital bankruptcy case in American history), Hospital Acquisition LLC and 25 related debtors d/b/a Promise Health and American Academic Health System (Hahnemann University Hospital and St. Christopher Hospital in Philadelphia) in Wilmington, Delaware, and Astria Health in Yakima, Washington. Additionally, EmpowerHMS owned or helped manage a rural hospital empire that encompassed 18 facilities across eight states. After funding from a controversial lab-billing venture dried up, 12 of the hospitals entered bankruptcy and eight closed their doors. There has also been a steady stream of lower profile cases, including Westlake Hospital in Melrose Park, Illinois, Penobscot Valley Hospital in Maine, and Springfield Hospital, Inc., in Vermont, and it appears that there are more filings in store. The webinar will discuss (i) the reasons for this growing trend of healthcare cases, (ii) the unique challenges in those cases, which involve not only the typical payment of creditor claims, but also the care of patients, (iii) the particular issues that arise uniquely in this class of cases, including jurisdiction over the Medicare and Medicaid Programs, treatment of provider agreements, the intersection of nonprofit law and bankruptcy law, and treatment of medical malpractice claims, and (iv) whether this trend of healthcare filings will continue.

The panelists will discuss upstart pharma bankruptcies, increased filings by care facilities and hospitals, the financial condition of rural hospitals, consumer medical bills, and medical records in bankruptcies.

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