MSO Opportunities Emerging

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In any given market area, the attorneys of the Presley Law & Associates can facilitate groups who have committed among themselves to engage in an integrated delivery system of sorts to implement an MSO model.

The Department of Justice and the Federal Trade Commission, in an effort to promote cost efficiencies in the health care industry as a whole, recognizes that “the health care industry is changing rapidly as it looks for innovative ways to control costs and effectively provide quality services.” Those departments now promote health care providers to form a wide range of new relationships and affiliations including both horizontal and vertical networks that can offer pro-competitive benefits to consumers.

MSOs are the new emerging strategy to advantage members in the market place with this encouragement from our Government. Once the decision to form these alliances has been made by local area providers, the attorneys of the Presley Law & Associates provide the capstone for the MSO by providing consolidation in all back office operations, including all billing services, transcription services, collections, claims management, and managed care contracting. (Remember this differs from a physician practice management company in that the physicians get the contracts, as opposed to a practice management company where the practice management company procures the contact for services for itself and then hires physicians to deliver the services as employees.)

The attorneys of the Presley Law & Associates will take these willing practices and horizontally integrate them into the MSO function. While each provider and physician participant still retains their independent entity format, outsourcing achieves multi-level efficiencies which are otherwise unattainable as individual practices. Once horizontal alignment is achieved, which begins with the execution of the Presley Law & Associates Agreement (MSA), vertical integration with hospitals and managed care plans can begin.

Immediately, Presley Law & Associates forms the corporate capstone, and will then set forth, for adoption, the agreed upon practice standards by specialty as well as for new member admission standards carefully defining all entry requirements that must be met by all other providers who wish to participate in the future.

The attorneys at the Presley Law & Associates take special care when dealing with payors to avoid price fixing claims, as well as when dealing with other networks in avoiding claims of illegal boycotting. The staff's strict adherence to its jointly adopted admission policies will prevent outside providers from claiming they were illegally excluded.

The key in forming the MSO is to employ the the Presley Law & Associate's business model that provides for provider integration that will produce significant efficiencies that concomitantly produce positive consumer benefits while utilizing carefully designed pricing agreements that are implemented, on a region by region basis, to achieve those efficiencies.

The legal team at the Presley Law & Associates has various rate plan structures that can be deployed in the market place among which are the following:

:: A capitated rate plan or one that offers a designated class of services for a predetermined % of the premium or revenue of the vertical health plan seeking to utilize the service of participating practices.

:: Various other risk sharing arrangements that establishes utilization targets for the network as a whole with provider participants being subject to rewards (pluses to base) or penalties (reductions from base) for meeting those targeted goals.

:: Alternatively a strict global fee arrangement could be utilized depending on participant approval and market conditions. (Remember each market is different and must be analyzed for anti-competitive effects.)

:: Even non-risk sharing arrangements within the MSO network will pass muster with the FTC so long as there is sufficient integration which will produce significant efficiencies.

Presley Law & Associates offers horizontal structuring which when completed allows for vertical integration with geographically strategic hospital organizations and health care plans that avoids anti-competition effects both inside and outside of the relevant geographically defined market area, while increasing practice profitability and improved patient care.

 

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