Search PubMed⌕ Search

Biomedical subjects

P K O'Hare

Publications and source records attributed to P K O'Hare.

At least 19 recordsLinked to original sources
PubMed2000

Some tax-exempt bond issues could become taxable.

The IRS recently launched a new program to audit healthcare mergers-and-acquisition financing arrangements. To date, the IRS has focused on transactions involving IDSs in which tax-exempt bonds issued on behalf of the participants have been used to prepay the outstanding debt of one or both participants. The IRS is concerned that such tax-exempt financing may involve impermissible advance-refunding of the previous debt, in which case the financing would be deemed taxable and the participants subject to penalties.

Capital Financing↗
PubMed1999

How to divest acquired physician practices.

When an integrated delivery system (IDS) determines it must divest itself of a previously acquired physician practice, it must manage the transaction with care. The IDS most likely will want to maintain a positive ongoing relationship with the physician practice, while avoiding concessions to the practice that could be construed as violations of state and Federal laws. Before proceeding, the IDS should evaluate the reasons for divesting the practice, assess legal issues involved in terminating contracts with the practice, decide how to deal with the practice's assets and office facilities, consider whether covenants not to compete should be enforced, ensure continued access to essential medical records, consider whether to incorporate a "non-disparagement" clause in the termination agreement, and determine what mutual general releases may be necessary.

Contract Services↗
PubMed1998

Terminating physicians from managed care organizations.

Changes are under way regarding procedures for terminating physician contracts with managed care organizations. Recent legal and legislative developments at both the state and Federal levels have afforded physicians additional rights to hearings when managed care organizations seek their termination from the provider panel. As a result, the termination process will likely become more difficult and expensive. Managed care organizations should, therefore, monitor their states' legislative activity regarding termination requirements and reevaluate their existing termination standards in anticipation of changing standards concerning physician termination.

Civil Rights↗
PubMed1998

Complying with physician gain-sharing restrictions.

Many IDSs are considering implementing gain-sharing programs as a way to motivate their physicians to provide high-quality, cost-effective services. Before embarking on such programs, however, IDSs need to understand the legal requirements associated with such programs to ensure that the gain-sharing arrangement is in compliance with Federal law.

Delivery of Health Care, Integrated↗
PubMed1997

Steps for winning state approval of integration transactions.

The powers attorneys general have to regulate integration transactions between for-profit and not-for-profit organizations may differ from state to state, but regardless of location, health-care executives planning integration transactions should take steps to help ensure that such transactions receive state approval. Executives should familiarize themselves with the attorney general's approval process in their state, be prepared to defend the valuation of any not-for-profit assets to be transferred as part of an integration transaction, review articles of incorporation and state statutes to make certain that the proposed transfer of assets is permissible, and ensure that the process for securing board approval to proceed with the integration is free from conflicts of interest.

Conflict of Interest↗
PubMed1997

Medicare and Medicaid risk contracting opportunities for PSOs.

Legislation has been proposed in Congress to allow provider-sponsored organizations (PSOs) to negotiate risk contracts directly with the Medicare program and, possibly, with Medicaid programs. Initially, qualifying PSOs would not be required to be licensed as HMOS, but would be required to demonstrate fiscal solvency and meet quality assurance standards. The proposed solvency requirements, as well as requirements regarding the proportion of commercial to Medicare enrollees in a plan, would not be as rigorous for PSOs as they are for HMOs. The legislation's proponents argue that relaxing requirements for PSO risk contracting will allow Medicare and Medicaid beneficiaries more healthcare choices and better benefit packages. Opponents assert that PSOs would be given an unfair advantage in the marketplace and that consumers may be exposed to a greater risk of plan insolvency. While details of the legislation need to be reconciled, many observers predict that it will become law.

Capitation Fee↗
PubMed1997

Not-for-profit status facilitates hospital merger.

Not-for-profit status may become an advantage for hospitals seeking to increase market share through a merger. On July 8, 1997, the Court of Appeals for the Sixth Circuit upheld the District Court's denial of a request by the Federal Trade Commission (FTC) to halt a proposed merger between two not-for-profit hospitals, Butterworth Hospital and Blodgett Memorial Medical Center, both in Grand Rapids, Michigan. The FTC had requested the District Court to enjoin the merger until the agency could determine whether it was in violation of Federal antitrust laws. The District Court was persuaded that mergers of not-for-profit hospitals do not generally lead to price increases, and may, in fact, lead to price reductions. Moreover, because the Michigan not-for-profit hospitals' boards included community representatives who were purchasers of the hospitals' services, the court found that "there would be no rational economic incentive for such an organization to raise its prices."

Antitrust Laws↗
PubMed1996

States wrestle with provider network regulation.

Across the country, states are considering whether to permit provider network participation in risk-based arrangements. Interest in this issue is driven primarily by market realities and, to a lesser extent, by two recent developments: the National Association of Insurance Commissioners' 1995 recommendation that provider networks entering certain risk arrangements be subject to state insurance regulation and last year's Federal health legislation allowing "provider sponsored networks" (PSNs) to enter Medicare risk contracts.

Capitation Fee↗
PubMed1996

Joint operating agreements: a new integration model.

Many healthcare system integrations are inherently contradictory: The participants want the benefits of integration but do not want to give up self-governance, relinquish title to their assets, or assume unwanted liabilities. A new integration model--the joint operating agreement--appears to resolve some of these concerns.

Delivery of Health Care, Integrated↗