Hospital and Health Care System Representation
Corporate Restructuring, Network and Integrated Delivery System Development
Members of the Health Care Practice Area and the firm have extensive experience in structuring and restructuring health care entities, creating new relationships among health care entities, and resolving the numerous legal issues that arise in connection with corporate reorganizations, affiliations and network/integrated delivery systems development. Through representation of health care institutions, physician groups and medical societies, the Practice Area has acquired a unique perspective with respect to integration of hospital and physician interests. This combination of experience has allowed us to provide our clients with highly effective representation in health system restructuring, network formation and the formation and operation of hospital-physician relationships. Our activities include participation in strategy and planning meetings regarding the merits of restructuring and analysis of the relative advantages and disadvantages of various models from both legal and operational perspectives. Familiarity with pertinent legal and practical considerations allows us to propose a range of alternatives for clients, based in part on the experiences of other health care clients, when selecting and effectuating a revised structure.
In addition to our experience in counseling clients as to the advisability of various approaches to restructuring, members of the Practice Area have implemented diverse plans of reorganization. Members of the Practice Area are presently involved in or have completed numerous such projects, including the following:
- Creating a regional health care delivery system, which includes two hospitals, a physician/hospital organization and for-profit subsidiaries.
- Restructuring the relationship between a large academic medical center and its medical facility practice plan.
- Advising a large multispecialty group practice on various issues regarding its affiliation with a multihospital system.
- Serving as outside general counsel to a national provider network, through which affiliated subsidiary and joint venture entities have been formed.
- Restructuring a multihospital system to support a focus on senior citizen issues and delivery mechanisms.
Medical Staff Bylaws and Credentialing
Attorneys in the Health Care Practice Area are experienced in drafting and revising medical staff bylaws, policies and procedures. The Practice Area has provided counsel in connection with a number of medical staff matters, including hospital-physician disputes regarding medical staff matters, managed care-related credentialing issues and disputes, and represented both institutions and physicians in due process hearings and civil litigation pertaining thereto. We have also assisted physicians forming independent practice associations ("IPAs") in developing an appropriate credentialing mechanism to minimize the IPA's exposure from both a tort and an antitrust perspective. Members of the Practice Area are currently counseling a hospital in its endeavor to implement an interdisciplinary approach to internal quality control and peer review.
Specialty and Multispecialty Physician Organizations
Attorneys in the Practice Area have provided substantial representation to specialty and multispecialty physician organizations in the areas of contracting, employment agreements, practice structuring, hospital relations, enforcement of restrictive covenants, and managed care. Representative projects include:
- Counseling a large multispecialty group practice in wide-ranging matters, including hospital medical staff relations, PHO relations, managed care contracting, possible corporate restructuring, labor matters and enforcement of restrictive covenants (including arbitration proceedings).
- Implementing corporate reorganizations and consolidations of physician group practices.
- Developing several single-specialty and multispecialty IPAs.
- Advising physician groups regarding development of "group practices without walls."
- Restructuring a joint venture among physicians in response to federal and state antireferral legislation.
Physician Recruitment and Retention
In a changing health care industry, hospitals and other providers face increased financial pressures to maintain and enhance revenue streams. At the same time, hospitals and physicians are recognizing the mutual advantages that come from close affiliation. As a result, institutions continue to pursue and expand their recruitment and retention programs. These programs range from more traditional recruitment methods such as loans, income guarantees, office and equipment leases and practice management and marketing assistance to physician practice acquisitions, provider hospital organization ("PHO") development and other forms of vertical integration. These arrangements must be very carefully structured to reduce legal exposure under antitrust, antikickback and tax exemption and designed with sensitivity to restrictions emanating from securities laws, the corporate practice of medicine restrictions, ethical constraints on physicians and other legal and regulatory constraints. Representative projects include:
- Design and implementation of a hospital system's physician recruitment and retention program.
- Counseling to restructure physician reimbursement under a medical faculty practice plan.
- Advising a hospital regarding antikickback and tax exemption issues associated with a physician office building initiative.
- Reviewing numerous physician contracts and recruitment/retention programs in connection with major corporate transactions such as sale of hospitals, hospital tax-exempt financings, hospital mergers, acquisitions and sales.
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