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AICPA

Robin Locke Nagele Presents on ACO/CIN Provider Denials and Terminations at AHLA's Physicians and Hospital Law Institute on Feb. 9

February 8, 2016

Health Care Principal Robin Locke Nagele co-presented, "ACO/CIN Provider Denials and Terminations: Procedural Protections, Immunities, and Databank Reporting”  for the Medical Staff, Credentialing, and Peer Review/Accountable Care Organization (MSCPR/ACO) Practice Group Luncheon at the American Health Lawyer Association's (AHLA) Physicians and Hospitals Law Institute in Austin, Texas.

Clinical networks and ACOs are beginning to confront the question of how to terminate substandard or underperforming practitioners without incurring material risk of antitrust, civil rights, or state court litigation from the terminated practitioners. The presentation examined this, and the questions:

  • Do the federal and state privileges and immunities that protect hospital privileging actions extend to ACOs and CINs (Clinically Integrated Network)?
  • Should ACOs/CINs elect to participate in the Databank reporting system, and gain the immunity protection of the Healthcare Quality Improvement Act?
  • Do the risks, headaches, and cost outweigh the potential benefits?
  • Does termination for failure to achieve quality metrics or comply with clinical protocols qualify as peer review?