Physician / Hospital Relations

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Physician Alignment Initiatives

Kutak Rock's national health care attorneys are experienced in the structuring of hospital/physician joint ventures and other types of physician alignment transactions, including clinical ventures between hospitals and affiliated physicians, as well as in broader service line and whole hospital ventures. We have served as transaction counsel in joint venture projects in more than 40 states. These have included multispecialty and orthopedic ambulatory surgery centers; specialty service ventures such as cardiac catheterization, advanced diagnostic imaging, cardiovascular CT imaging, vascular services, radiation oncology and other cancer treatment services, endoscopy, nuclear medicine, sleep lab, LTACH, cyber knife and women’s health; specialty hospitals, including orthopedic, heart, spine, neuro-spine, surgical and short-stay hospitals; and general hospitals. We also developed a Physician Affiliation Toolkit, which included the development of guiding principles for joint venture transactions as well as model documents.

In structuring health care affiliations that involve physician nonprofit hospital partners, our national health care lawyers have developed strategies for governance structures designed to satisfy the needs of the for-profit participants while addressing IRS sensitivities that arise in connection with joint ventures involving exempt and nonexempt organizations. Our strategies are designed to provide effective integration while complying with Anti-Kickback Statute, Stark Law and other legal requirements. We also advise on reimbursement issues that impact joint venture structures, such as whether the joint venture will provide services as a freestanding entity or as a hospital-based entity or an “under arrangements” service provider. Each of these structures has intricate reimbursement analyses and considerations that often impact the structure, business model and overall feasibility of a joint venture.

Medical Staff Credentialing, Quality Improvement and Peer Review

Kutak Rock's national health care attorneys regularly advise a broad range of providers regarding credentialing, quality improvement and peer review matters. We  assist medical executive committees and governing boards address quality of care and behavioral concerns strategically to accomplish educational or disciplinary objectives while complying with the Health Care Quality Improvement Act of 1986 (“HCQIA”), National Practitioner Data Bank (“NPDB”) reporting, and state regulations, as well as protecting the confidentiality of peer review, quality assurance and utilization review deliberations and documents. Kutak Rock's national health care lawyers regularly draft and revise medical staff and hospital bylaws and participates in administrative actions and litigation related to credentialing and privileges.

In peer review matters, Kutak Rock is able to provide strategic advice based on our detailed understanding of NPDB reporting requirements to avoid unnecessary escalation and to help ensure that the solution fits the problem. Our health care attorneys are experienced in responding to proceedings before the Secretary of Health and Human Services when an NPDB report is disputed. We defend health care providers against potential liability claims, including tort claims based on peer review proceedings, asserting all relevant privileges and immunities.