This article is more than 5 years old. Information may no longer be current.
Many options exist for surgeons to joint venture with hospitals
Click Here to Manage Email Alerts
|
|
KOHALA COAST, Hawaii — One way for orthopedic practices to add ancillaries and value-added services is to joint venture with hospitals, according to an attorney specializing in medical law. However, changes due to health care reform legislation may make it better to hold off on these projects until the actual laws are passed.
“Joint venturing means many things to many people” said David M. Glaser, JD, at Orthopedics Today Hawaii 2010, here. Opportunities for orthopedic surgeons to enter into partnerships with hospitals include: gainsharing; medical directorships; and management ad recruitment assistance.
“All of them can work,” he said. However, in certain states it may not be possible to enter into all forms of joint ventures, especially those requiring certificates of need. Geographic location also can limit the ventures available for a practice.
Anti-kickback law
It is important for surgeons who treat Medicare patients to be aware of Medicare anti-kickback legislation, he said.
“It is illegal to offer, solicit, make or receive any payment intended to influence referrals under a federal health care program,” Glaser said. “The government applies the ‘one purpose’ test. If one purpose of the payment is to influence referrals, the payment is illegal.”
Glaser noted the following kickback basics:
- The law does not apply to payments within a corporation, so if the ancillary is owned by a hospital or clinic alone, the anti-kickback law is not a factor;
- The anti-kickback law is a criminal statute; and
- The government (and whistleblowers) has been willing to use it.
However, Glaser noted, it is also important that these ventures abide by Stark laws.
“Under Stark, you have to have certain safe harbor provisions that aren’t needed under the Medicare anti-kickback law.” Payments must be set in advance; payments may not vary based on the volume of referrals; and there must be a time limit set on the term of the agreement.
Getting in trouble
Glaser said the way to get in trouble with joint ventures is to take an offer which requires no actual action by the physician, or physicians threatening a hospital to go to another unless his or her terms are met.
“When people offer you money for nothing, that is a problem,” Glaser said.
However, many of the rules involving adding ancillaries to orthopedic practices may change with the pending health care reform legislation.
Gainsharing is legal as long as you follow the proper parameters, he said.
“Federal law prohibits payments intended to reduce services to Medicare beneficiaries. So structure the deal accordingly,” he said.
- Reference:
Glaser DM. Pros and cons of joint venturing with hospitals. Presented at Orthopedics Today Hawaii 2010. Jan. 10-13, 2010. Kohala Coast, Hawaii.