The Value-Based Dream TEAM?
- APMConnect
- Jan 2
- 2 min read
How CMS’s New Payment Model Could Spur Widespread Adoption of
Value-Based Arrangements
Justin at Bass Berry & Sims shared this article he wrote with a colleague regarding TEAM arrangements. Justin, regularly advises on complex health care regulatory issues, like Stark Law, Anti-Kickback Statute, and state analogs.
See below exerts. Access the full article by Justin K. Brown, Bass Berry & Sims PLC
Travis G. Lloyd, Bass Berry & Sims PLC below.
Although the CMS-sponsored model safe harbor will protect TEAM sharing
arrangements from the Anti-Kickback Statute, that alone will be inadequate for many hospitals.
Through the VBE framework, however, hospitals and other providers can use the value-based exceptions to the Stark Law and safe harbors to the Anti-Kickback
Statute. These exceptions and safe harbors generally do not require remuneration to be consistent with fair market value, and they allow volume-sensitive compensation.
Up to this point, many hospitals and health systems have made limited use of the value-based exceptions and safe harbors to the fraud and abuse laws. The requirements may appear onerous, or at least unfamiliar, and oftentimes hospitals can meet their strategic objectives through use of other, more familiar exceptions and safe harbors.
TEAM, as perhaps the most ambitious mandatory alternative payment model created by CMS to date, may change that. Although hospitals can continue to rely on the familiar framework, they may, in the face of the need to design novel, extensive financial arrangements with other providers, avail themselves of the VBE
framework. Importantly, the TEAM program requirements themselves go a long way toward providing the infrastructure necessary for TEAM participants to make use of the VBE framework. In this respect, TEAM does much of the heavy lifting.
TEAM represents a critical operational challenge, and an important opportunity, for hospitals. It just might also have the effect of changing the way in which hospitals and health systems make use of the value based exceptions to the fraud and abuse laws.
Access the full article by Justin K. Brown, Bass Berry & Sims PLC
Travis G. Lloyd, Bass Berry & Sims PLC
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