On June 12, 2024, Attorney Steve Boell served on a panel discussion entitled “Navigating Key Legislative Issues Facing Healthcare Leaders” before members of the American College of Healthcare Executives (ACHE) at Brookside Country Club. Moderated by Sheilah Borne, VP of Government Health Relations at Penn State Health, Steve was joined by fellow healthcare industry leaders Kyle McLemore, Senior Vice President, Operations at BSI Corporate Benefits and Jennifer Cicconetti, PharmD, BCPS, BCGP, BCMTMS, Director of Pharmacy at Valley Health Partners Community Health Center.
The event was organized to address several recent pieces of healthcare industry legislation that largely impact the already heavily regulated sector. Topics included:
- FTC scrutiny of private equity healthcare – recently the FTC joined the Department of Justice’s (DOJ) Antitrust Division and the U.S. Department of Health and Human Services (HHS) in launching a cross-government public inquiry into corporate and PE healthcare acquisitions, which are on the rise. Concerns center on competition, increased healthcare costs, and patient care, notably when a single private equity firm acquires a significant market share in a geographic region.
- PA Antitrust activity – with a steady rise in healthcare M&A, the state is obligated to review hospital transactions, especially when a for-profit acquires a non-profit, or when the conduct might be anticompetitive under federal antitrust laws.
- FTC noncompete ban – for decades, healthcare noncompete clauses have been viewed as a way for hospitals and health networks to ensure the continuity of their workforce and discourage restricted employees from leaving employment. Should the FTC noncompete ban go into effect in September, some critics believe it will create an anti-competitive, unlevel playing field between for-profit and nonprofit healthcare entities, as well as threaten access to high-quality care for millions of patients. Additionally, healthcare providers should consider retention strategies like enhanced NDAs, non-solicitation agreements, and carefully tailored training reimbursement agreements.
- Impact of artificial intelligence (AI) on privacy – the Office of the Inspector General (OIG) is already investigating some electronic health record (EHR) systems using AI to determine if they induce practitioners to order medically unnecessary tests and pharmaceuticals. In 2023, the White House issued an Executive Order requiring the Department of Health and Human Services (HHS) to develop a regulatory action plan for predictive and generative AI-enabled technologies in health care, as implementation of any AI product accessing protected health information needs to be viewed through the lens of HIPAA. The industry awaits the outcome of the order later this year.
- No Surprises Act – intended to address unexpected gaps in insurance coverage that result in “surprise medical bills” when patients unknowingly obtain medical services from physicians and other providers outside their health insurance network, this law requires insurers and out-of-network providers to negotiate what both sides agree is a fair payment. When agreement can’t be reached, a federal independent dispute resolution (IDR) process begins, and the courts have been inundated with IDR requests, with 61% remaining unresolved.
- Private practice goes before the Ways and Means Subcommittee on Health – independent practices are rapidly becoming extinct due to several factors like reimbursement, staffing shortages, administrative burdens, cyberattacks, inflation and the lingering effects of the pandemic. The Medical Group Management Association (MGMA) submitted a formal statement before the Subcommittee and are urging them and Congress to act, allowing independent practices to survive and provide high-quality care to their communities.
Legal support for healthcare industry legislation
As one of the senior members in the FLB’s healthcare team, Mr. Boell regularly represents health systems, practices, physicians and others in the healthcare industry in a variety of transactions and proceedings, including compliance with the Federal Stark and Anti-Kickback Laws, and the structuring of joint ventures. He uses his experience in the real estate industry to advise and assist clients with the development of hospitals, healthcare campuses and medical office buildings. He also represents physicians in the negotiation of contractual relationships such as employment agreements and in the sale and acquisition of practices and equipment.
FLB’s healthcare attorneys in Allentown are committed to excellence, personal service and responsiveness to our clients working in the complex, heavily regulated and constantly changing healthcare industry, including hospitals, health systems, ambulatory surgical facilities, assisted living facilities, physician groups, rehabilitation facilities, home healthcare agencies, and medical device manufacturers throughout the Mid-Atlantic region. Our healthcare attorneys regularly publish articles and speak to physicians regarding emerging trends and new regulatory requirements, as well as collaborate with colleagues in other practice areas like employment law, real estate law and corporate law, as these areas of law regularly impact healthcare.
Thank you, Steve, for your leadership and remaining up to date on current healthcare industry legislation impacting organizations and professionals in the region!
