New Value Based Payment Mechanisms, Ancillary Revenue Streams, and Stark Law w/ Nicholas F. Alarif

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Erik Sunset: Hello and welcome back. I’m Erik Sunset, your host of the DocBuddy Journal. Here at DocBuddy we deliver healthcare solutions to take the pain and costs out of broken workflows. From the ASC to the clinic to On-call at the hospital DocBuddy helps providers access create and move data seamlessly all from the point of care and learn more about all of our solutions.

Erik Sunset: And set up a demo at docbuddy.com. Today we’ve got a special guest. We’re joined by Nicholas Alarif, who is a partner at McDermott Will and Emory’s Washington DC office. His practice is focused on healthcare regulatory fraud and abuse matters, including the physician self referral law, commonly known as the Stark Law, False Claims Act, the federal anti kickback statutes, [00:01:00] and other healthcare compliance matters.

Erik Sunset: Nick also advises clients on the complex legal and factual issues surrounding Medicare Parts A through D reimbursement and other CMS services payment policies. Nick, thanks for joining us.

Nicholas Alarif: Erik, thanks for having me. And, uh, yeah, looking forward to this conversation, uh, and talking, talking to everybody’s favorite, favorite subject matter,

Nicholas Alarif: uh, Stark compliance, right?

Erik Sunset: There’s a lot of layers to that onion. absolutely in this audience, uh, should be aware of all of the intricacies of the Stark law operating physician organizations, obviously. So we’ve got a pretty good look at your, uh, your professional rundown there.

Erik Sunset: What else should listeners know about you?

Nicholas Alarif: Yeah, no, sure. So, um, just, just a little bit about my, my background. Uh, I’ve, I’ve done, I’ve done the big three from, uh, from a health counseling perspective, as I like to call it. Um, I started out in government at the centers for Medicare and Medicaid [00:02:00] services, as well as the department of health and human services, uh, regulating, regulating, the industry from a, uh, Stark law, fraud and abuse perspective and reimbursement perspective, uh, for a little bit and, um, uh, came back to the firm environment.

Nicholas Alarif: So, so I’ve seen all the angles and, and, uh, I’m happy to be, be back in McDermott here after a short stint, uh, in house

Nicholas Alarif: although I loved, I loved in house as well.

Erik Sunset: Uh, it gives you a great perspective having seen it from all sides, like you said. Has it, has it always been healthcare or was there a path that brought you to healthcare?

Nicholas Alarif: Yeah, no. So, um, so, so my dad was a doctor, um, grew up in a medical household, did his billing sort of, he would, he would argue on that, but, but, um, Was really interested in actually government contract law Which led me in law school to the False Claims Act, which got me back brought me back to health care. So it’s been a [00:03:00] Circular path, but but all roads lead back back to our wonderful

Nicholas Alarif: payment system. So

Erik Sunset: And we’re, we’re together today, uh, as listeners of the show will know, DocBuddy will be attending McDermott, Will Emery’s PPM and ASC symposium in Nashville next week, which is going to be a great event. And you’re a speaker on a panel, Critical Strategies for Improving the PPM’s Bottom Line, which is on Thursday at two o’clock Nashville time.

Erik Sunset: So without spoiling the panel, obviously, what are you hoping some of the key takeaways for the audience will be?

Nicholas Alarif: yeah. No, I think it will be a great Fantastic panel. We, um, are going to be hosting some of the largest PPM platforms for specialty care in urology and gastroenterology. Some, some, some leaders of those organizations will be. Just talking about their experience from a, um, strategy perspective, what they’re doing in this [00:04:00] current financial market as it, as it exists, and some strategies they’re taking advantage of, uh, also going to have great McDermott speakers outside of me, uh, Joe Parisi is going to be leading that, that panel. Um, and, and he’s, he’s. He’s going to, I think, kind of just try and go back the onion on on what, what folks are just doing to, to deal with and grow their, grow their platforms again, in this environment we’re in where, where it may be harder to do some of that acquisitional, uh, strategy. And so you’re kind of growing from within.

Nicholas Alarif: And I think some of our panel speakers will talk

Nicholas Alarif: more

Nicholas Alarif: about what they’re doing.

Erik Sunset: And that’s so timely. I mean, the title of the panel, critical strategies for improving the PPM’s bottom line, I’ll come out and say it. Huge financial pressure on physician organizations, reimbursements falling, you can’t hire entertained staff. There’s a lot of headwinds in this space. So these physician [00:05:00] organizations and PPMs, Scratching and clawing to keep the lights on in some instances while still delivering outstanding patient care.

Erik Sunset: We talked before recording about some of the right ways to structure ancillary revenue streams, because as you said, sort of transactional growth or inorganic growth is a little tricky in the broader economic climate, uh, today. So what is the right way to structure ancillary revenue streams without going afoul of any laws or regulations?

Nicholas Alarif: Yeah, no, that’s a great question. And I think something that organizations can. Really leverage internally right now, uh, if done the correct way. So of course I’m coming up from it at it from a regular health regulatory perspective. That’s, that’s what I do. Uh, and, and when you’re talking about ancillary revenue, for instance, clinical laboratory services, uh, your diagnostic imaging. Any if you’re in an orthopedic type of [00:06:00] environment, you know your demipose type things all of those services if they’re paid for by medicare are going to be covered by the stark law And even outside of even outside of those ancillary services, you may be running into the anti kickback statute. So, uh, that’s all big, bad and scary, you know, um, with regard to false claims act liability, uh, and criminal liability.

Nicholas Alarif: If you’re under the anti kickback statute regime, uh, which you, which you are, but there are ways to do all these things, I think, in a way that, um, mitigates risks from both those laws, uh, and can create, uh, Real physician alignment with the organization achieving the goals. Um, and so, you know, That’s something that i’m hoping to talk about on that panel bringing it back to bringing it back there Is what are what are some of those things you could do?

Nicholas Alarif: And and one of those things is a lot of our clinics and ascs are becoming Our clients and ppm platforms that [00:07:00] have those types of entities are I don’t think it’s a secret. We’re seeing bigger and bigger platforms very much We’re seeing, um, you know, Hugh doctors that don’t necessarily want to get aligned with a hospital system, seeing a PPM as a viable alternative, alternative that will, uh, them grow, um, with, with sometimes the help of, uh, you know, outside investors. And, and what we have seen are some, um, in recent years, helpful guidance from CMS, which is, sounds like an oxymoron, but, but helpful guidance from CMS that allows for, uh, structures that can facilitate, uh, effective, um, use of ancillary, such as a, as a clinical laboratory, which can sit under what may have been, uh, multiple practices that have come [00:08:00] together. And so now you get those economies of scale, and that allows for physicians to effectively, um, potentially, uh, share in that profit stream, which, which may not have been as, uh, as clinically, uh, integrated before. Now, now, with, with some of this guidance, if you structure it correctly, You can really take advantage of those income streams and lower, uh, the overhead costs of providing those ancillary services to your client base. So I think those are some exciting, that’s an exciting development. Some other things that we are talking about a lot with our clients right now is, um, how we distribute and can share ancillary profits. With them in a way that incentivizes them, um, to, to, uh, be productive, but also is compliant with the law, which is tough to do, but there are ways that, you know, the, the Stark law, we, we [00:09:00] usually have clinics, um, and, and, and practices that are structuring themselves to meet what we call the in office ancillary services exception. And one of the, I think one of the big. Uh, things that you can do is as long as the profits indirectly relate to the volume or value of referrals you can Have some strategies that will allow physicians to to benefit from those Ancillary profit lines and so that’s something we work with clients all the time on is how we do that in a way That’s regulatory compliant, but Achieves the business goals of the organization.

Nicholas Alarif: Um, keep the lights on.

Erik Sunset: And I would imagine in a lot of ways too that if you’re, if you’re doing so compliantly, you know, being able to access those ancillary revenue streams, that has to go a long way towards patient outcomes as well. Your services are all provided out of, under one roof, uh, as it were. Do you hear any feedback from clients on, on that?

Erik Sunset: [00:10:00] I

Nicholas Alarif: Yeah. No, it’s a great great point, Erik. Like, um, there’s, there’s a lot of, uh, when you have that continuity, you, I think, are providing a patient experience that is a lot more, uh, integrated and, and, easier to access, and it’s kind of becomes more of a one stop shop. And with, uh, with the change from, I would say, generally, um, a more outpatient base, uh, centric payment, uh, payment, the old payment incentives to do services in the hospital is just disappearing and we’re seeing all these services that used to only be done at a hospital really be done in the Uh, clinic setting.

Nicholas Alarif: And so I think that that’s a win win for everybody that that allows for that’s less expensive to the government that allows for more, um, control by by physicians to [00:11:00] to produce those outcomes that I think, uh, make care easier to achieve to to get from a from a patient and not require them to go to 10 different places to get

Nicholas Alarif: to get

Nicholas Alarif: what they need.

Erik Sunset: think that’s particularly interesting and timely too, because there’s sort of a duality of medicine when you’re face to face with a provider, as a patient, it’s all about you as it should be too, by the way, in my opinion, when you’re faced with a provider and you’re their patient, it’s all about you and your outcome and what can we do to get you moving better or feeling better or cure what ails you, right?

Erik Sunset: But there’s the other side of the coin where the lights have to remain on because at the end of the day, You know, medicine is a business. Otherwise you will not getting any treatment period. But then the bigger picture is what you just hit on is that, that triple aim of healthcare, you know, good for the patient, good for the providers and then good for the system.

Erik Sunset: You know, we’re, we’re having a sort of Medicare focused talk today, but payers as a whole are [00:12:00] the third leg of that stool really, and it’s high time that we address it as it is. It’s no longer how the sausage is made. You know, if you like me as your provider so much, well, I need to have patients that I get reimbursement for.

Erik Sunset: So hopefully there’s a, it’s a broader shift in the workplace than what I’m just seeing from where I sit.

Nicholas Alarif: Yeah. No, that’s a great, great point. I, I, I hope, I hope you’re right that, that, that we’re getting, getting that alignment, keeping the lights on and everybody’s happier and, and, and,

Nicholas Alarif: uh, hope

Nicholas Alarif: that trend continues.

Erik Sunset: Yeah, it’s high time. We don’t have to throw any of the stats or figures out there about how much America spends on healthcare as a whole and as a percent of GDP, but something needs to change and hopefully we’re moving in that direction. So to bring us back to our, our central theme here, we talked a little bit about Stark law and anti kickback with the right way to structure these ancillary revenue streams, maybe for those that need a little bit of refresher [00:13:00] Stark law and anti kickback get thrown around an awful lot.

Erik Sunset: But maybe listeners don’t know exactly what it is that’s being referred to. Can you give us the 30, 000 foot view here on what we’re actually talking about?

Nicholas Alarif: Yeah, no, I’ll do my best. Uh, so what we’re really talking about are, um, some, uh, very old laws at this point. I think the anti kickback statute, for instance, is, is, you know, 50. It’s been with us for at least 50 years now. Um, Stark law first came about in the nineties. It’s had a couple iterations at the end of the day.

Nicholas Alarif: These are two laws that are getting at conflicts of interests, uh, whether rightly or wrongly that the government identified as potentially creating, um, uh, uh, risk from a, uh, financial alignment perspective with physicians making referrals for services payable by. These federal health care [00:14:00] programs.

Nicholas Alarif: Tentatives that they have, they have, uh, a financial interest with rather than what may be necessarily the best, um, place for a patient to get care. And so that’s the policy behind, uh, the pros that we have, which are very, very, uh, wonky, especially with the Stark Law. The main difference between the two laws is the kickback statute applies to everybody. And it’s a criminal law. Um, it is intent based, which is means that you have to mean to violate it. And with that, though, comes potential criminal liability, which I think, which I think is scary for a lot of people. But, uh, You know that that that is not typically Where we how how we although there are plenty of criminal enforcement actions with the anti kickback statute I’d say we more see it in the in the civil side where it’s the predicate case for a false claims act Uh case where which is kind of a whistleblower type case That’s how the anti kickback statute and the [00:15:00] stark law are typically enforced Is that a whistleblower will say I know you violated those laws I’m going to bring a case in, in, in, in their name and I get to collect some of that money, uh, whether the government ends up bringing it for me or I bring it myself. So that’s the kickback statute intent based applies to everybody. Starclaw is a little different. Pete Stark is the founding father, so to speak, of that. He’s, uh, and he saw that the kickback statute, more or less, was not hitting everything he thought it was. And, and so he said, well, what would really work would be a strict liability law, meaning there’s no intent that anybody has to prove. So if we have a physician, That makes a referral for a quote unquote designated health service Which is really typically we’re talking about those ancillaries where I was getting at they make a referral Uh to an entity with which they have some type of financial relationship whether that be ownership [00:16:00] whether that be just a You know, uh, call coverage arrangement to make a referral for the designated health service. They’ve got to meet an exception to the Stark law, um, basically a, uh, formula for how that financial relationship typically has to work. So, uh, is the compensation that the physician’s receiving fair market value is the arrangement in writing? Is it signed by the parties? A lot of those are requirements for compensation arrangements. When we’re in the um, when we’re in the clinic space We are dealing a lot of times with a physician that owns their own entity that’s billing for the designated health service, right? So a lot of I think a one common misconception Is that the stark law doesn’t apply to clinic services potentially and that um, that it only That that if if i’m if i’m the if I own my own practice and I bill for a da An ancillary service that’s a designated health [00:17:00] service You It’s not really affecting me.

Nicholas Alarif: Well, that’s unfortunately not true. Uh, Stark law is extremely intrusive into how physicians go and compensate themselves. Um, so, so, we need to be very wary of making sure we structure compensation arrangements, um, to meet an exception to the Stark Law. And there is a huge one that everybody uses for purposes of protecting that ownership interest the physician has in their clinic. It’s called the in office ancillary services exception. So, um, so, That’s that’s probably more than you wanted to know And I hope I hope I didn’t put everybody to

Nicholas Alarif: sleep with that with that diatribe.

Erik Sunset: No, but it’s, it’s, it’s mission critical. I mean, nobody, at least I think most people don’t go through their day thinking about, um, laws on the books, whether you’re a physician and you’re thinking about Starclaw day in and day out or whatever else it may be, but you need to be aware of these things.

Erik Sunset: You’re [00:18:00] operating a business. And to run afoul of Stark law and anti kickback, especially with the, uh, the liability basis of the Stark law versus the intent base of the anti kickback statutes. That’s a big deal. And businesses, like we said, you know, we’re making this is how the sausage is made. Medicine is a business.

Erik Sunset: You must be aware of these things. And kind of to that point, Nick, what are some of the common mistakes that, that happen either that you see or that, uh, that are more broad as a, as a common mistake, running a foul of StarClock?

Nicholas Alarif: Yeah So I I really do a lot of work on the the physician practice acquisition side of the house here at the firm I do a lot of transactional support basically being a You know a glorified housing inspector When it comes to making sure that whatever somebody is buying, whether it be a clinic, uh, ASC, that that we all [00:19:00] have, all the pipes are in order, everything’s working correctly. And from a clinic perspective, what I see a lot of times when, um, one of our clients would like to purchase, uh, or invest in through an MSO or depending on the corporate practice of medicine considerations, would like to invest in a, a, a practice. What I see a lot of times running afoul from a Stark Law perspective is how physicians, uh, compensate themselves.

Nicholas Alarif: Thanks. Now, this is what we, the issue we see a lot of is physicians being paid on a, um, I’ll call it, uh, an eat what you treat model that pays physicians based on a percentage of all the revenues and doesn’t treat, um, uh, Ancillary services or the designated health services any differently than how they treat everything else Uh, I said eat what you treat.

Nicholas Alarif: Some people say eat what you kill. I think medicine you treat sounds a little bit nicer, right? Um, so [00:20:00] so that’s a common mistake we see where And you’re like, well, why does that sound why is it that sounds pretty normal, right? Like shouldn’t people be paid for what they’re doing? And it gets nuanced. Um, if it’s all based on the personally performed services of a physician, it can be okay. But the minute that you have a physician getting paid, uh, for services that maybe they order, uh, even though you may think, Oh, I’m personally performing it. If you have somebody else do a certain service, that is a designated health service, And that, and the way that that physician is, is getting compensated, um, direct, takes into account directly their referrals they make for that service. We’ve got to think if there’s a stark flaw kind of exception that is available to protect that type of arrangement. And sometimes there isn’t, sometimes there is, depends on the size, scope of the, of the practice. But that’s probably the most [00:21:00] common mistake I see, um, and, and. A lot of times we are working with a either our client to fix those types of arrangements and they are fixable and there’s ways to mitigate any risks surrounding these.

Nicholas Alarif: It’s, it’s, it’s very routine because it is such a common mistake, uh, potentially. Uh, so a lot of times we’re working on that side of the house, uh, either for a client buying a practice or When we’re working directly with a client to fix those things, maybe they’re getting ready for a transaction. Maybe they just don’t want to have this regulatory risk hanging out there.

Nicholas Alarif: So that is, I would say, the most common mistake in the clinic perspective from a

Nicholas Alarif: Stark Law angle.

Erik Sunset: Well, let’s, let’s go to the other end of the spectrum too. And I’ll paint just a really short picture from my days in the revenue cycle space that when you’re looking at billing and coding, There are certainly those that will abuse that system, and they will get their just desserts. But then there’s the other end of the spectrum that’s overly cautious.

Erik Sunset: And [00:22:00] interestingly, if you’re a chronic undercoder, The payers in Medicare are going to have a similar conversation to those that are more aggressive in their coding, going, What are you doing? You’re not treating anybody with any degree of severity. What are you on our panel for? I mean, they do that out of an abundance of caution.

Erik Sunset: If I just under code everything, nobody’s going to be looking at me, and I’ll be okay. And they, you know, at its core, are leaving money on the table, and they’re also not adhering to the contracts in place with a given payer, which is not good. What are some of the misconceptions around Stark Law where folks are overly cautious and it’s either hurting their top line or bottom line, or it limits their ability to treat patients how they maybe would really want to?

Nicholas Alarif: Yeah. Oh, wow. So I will say, Erik, a great question here that unfortunately, for better or worse, some might say the Stark Law Is a lot of form over substance and sometimes when we’re doing these analyses because again, it’s a strict liability law [00:23:00] it is just Uh, you you have to meet these requirements. It doesn’t matter what your intent is again So a lot of times people will say well, I don’t want to deal with this Uh, DHS and Stark law ancillary.

Nicholas Alarif: So I’m just going to pay physicians, nothing related to the profits of what they, you know, maybe I, maybe I’m an owner of a practice and I have a bunch of employed physicians, I’m just going to pay them only on their personally performed service, nothing else, nothing else, just, just a WRBU type calculation. And the answer there is if you meet. The group practice definition, uh, which is very complex under the Stark law, and you can take advantage of the in office exception, which is again, where we typically, what we typically use, uh, you can share profits with your employed physicians, with your independent contractors, even from those designated health services. It just has to be done in a way that doesn’t directly take into account the referrals. And CMS has [00:24:00] Basically given some, uh, look, you do it this way, you know, you’re safe type scenarios, and it doesn’t mean you have to do it that way, but there are ways you can share those profits with those individuals to incentivize them, to align them with the keeping the lights on of the organization. Uh, and, and so it doesn’t need to be this, this all or nothing type of approach. We can do things. to align physicians that aren’t, that aren’t directly related to their referrals, but certainly, certainly will get those physicians to, uh, uh, be incentivized to provide, provide care to patients and be, be, be,

Nicholas Alarif: productive.

Erik Sunset: Well, that makes sense, and when you, when you look at some of the newer data around, Physician burnout, like a lack of autonomy, is a self reported driver of burnout. We know we’re kind of on this precipice of [00:25:00] a shortage of physicians that’s going to be a cataclysm in the next five to ten years from retiring early, not wanting to put up with all the red tape, not wanting to put up with the bad technology and use.

Erik Sunset: So I think that’s really timely and to bring it back to the panel, critical strategies for improving the PPM’s bottom line. And by extension, the physician organization’s bottom line, just one quick thought on human nature. You know, if I’m a Powerball winner tomorrow, I’m thinking about a tea time. I’m not thinking about work, right?

Erik Sunset: Like you potentially rather be on the beach. There’s certainly those that rather build your Elon Musks, your Bill Gates. They’re just on this earth for one thing and one thing only. And that’s great. Glad we have folks like that. But I think for the most part. You know, you’re, you’re doing a job so that you can have the lifestyle that you want.

Erik Sunset: And lifestyles obviously are not free. They cost money. So it’s a really long walk for kind of a short drink of water. And we’re looking at ways to increase revenue and be able to treat as many patients as your panel and the hours in the day [00:26:00] allows. There’s some interesting things happening around value based care, where Stark Law and these anti kickback statutes, which, uh, love them or hate them, they’re there.

Erik Sunset: They’re there for a reason. They may allow for some new payment mechanisms. So what are you seeing on that front?

Nicholas Alarif: Yeah, yeah, and, um, this is just a hot topic all over healthcare. Um, it’s a hot topic, I think, at some level, because value based care can mean a lot of things to a lot of different people. Um, so, pick, pick your definition. When I talk about value based care in my practice, I’m talking about, uh, some really cool developments that have occurred recently on a stark line anti kickback side.

Nicholas Alarif: Thank you for your time. Last couple of years, it was a big rule change where we saw the introduction of some new exceptions to the Stark law and new safe harbors, uh, to the anti kickback statute, um, that allow for new payment models [00:27:00] to flourish and not run a foul of these. Again, as I noted, these are kind of old laws. They were developed during a fee for service system of care. Pay you, you, you prefer a patient to get paid or a patient to get paid. That’s how it worked. So, the laws are designed to, in that kind of world, we move from that. Now we’re talking about the triple, quadruple aims, and how we’re, how we’re supposed to, and, and, and I think quality is, and, and, and continuity of care, these are all really important topics, and really important to, uh, providing care in a way that, that makes sense, that is smart, not just formulaic. So, These new safe harbors and exceptions. I mean, from a, from my perspective, the Stark law exceptions really are an interesting development for clinics to really think about from practices to really think about, because, you know, I was talking to you about those volume, [00:28:00] volume value kind of strictures that exist that you can’t pay physicians directly based on the volume of value of their referrals, that a lot of the exceptions require that compensation be fair market value, right?

Nicholas Alarif: These are big constraints. especially in potentially a value based care scenario where you may be paid based on ordering a certain test that is in the best interest of a patient. But maybe that test is DHS. It’s that ancillary, but that’s what you should be doing. That’s the standard of care. So, the Stark Law exceptions, for instance, recognize this and allow, if you become, meet quote, unquote, certain regulatory requirements of being a value based enterprise and hitting a value based purpose. If you do all those things, you meet the exception, you meet the definitions. You can pay physicians to align to achieve those value based purposes based on the volume or [00:29:00] value of a physician’s DHS referrals. It doesn’t necessarily have to be fair market value if it’s achieving and moving towards value based care. And I’m throwing these terms around without very good definitions of what is value based care. What is a value based purpose? Well the thing is CMS also Uh, didn’t give very strict definitions here, and that was on purpose, and that’s because it could be so many different things. It may be that a that, you know, there’s, there’s a guideline that is really important that, that in ortho orthopedics, that needs to be, uh, that’s really beneficial for increasing outcomes for a particular surgery.

Nicholas Alarif: Maybe you are ordering X, Y, and Z tests. That really help with the potential after a hip replacement or something that, that stops them from, from going back to the hospital and impacts or increases [00:30:00] their, um, the effectiveness of that, of that surgery. Maybe that’s physical therapy. Maybe it’s something that it would otherwise be a DHS. If you are structuring this for a target, a particular patient population in a way that enhances that value based care, CMS basically said, here are the keys, do your own models, show us how you, how these financial alignments will achieve those value based purposes, and we’re not going to bother you with the start block. Maybe we’re, and I think that is really something interesting that, um, a lot of clinics and practices could start thinking about taking advantage of, whether that’s internal with some of your employed physicians, whether that’s with a hospital system. There’s just a lot of, a lot of opportunities, I believe, um, to take advantage of these new exceptions and safe harbors that are, that have been promulgated by the,

Nicholas Alarif: uh, department of Health and Human Services.

Erik Sunset: And I can’t imagine [00:31:00] having, uh, recently written laws on the books that were accidental in their loose language. I think that shows some good foresight, maybe some lessons learned from something like the, uh, the high tech act and the meaningful use,

Erik Sunset: so glad to hear that. That’s gotta be gratifying for you in the seat you sit in.

Nicholas Alarif: It is fun to help clients with it too. I mean, it’s just, uh, you know, saying, saying, being able to help them actually. move goalposts for patient care, uh, and not have these laws that are a lot of time spent a hindrance to them be potentially like, well, we have a, we have a, we have a, we have a solution for that is, is gratifying.

Nicholas Alarif: It is really great. Great to not always be the no guy.

Erik Sunset: Well, you know, the old saying, you, you, you don’t generally, uh, retain a lawyer to not take their advice. So that’s, uh, that’s good for all parties concerned. Then just a quick note, um, it is tough to pin down what value based care is or isn’t. What do [00:32:00] you mean when you say value based care? Well, it’s different from what I thought it was, but we’ve been talking about the PPM and ASE symposium, which is Wednesday and Thursday.

Erik Sunset: Uh, next week. So that’s May 15th and 16th in Nashville. There’s also a value based care symposium happening that Friday, also at the Omni in Nashville, uh, hosted by McDermott, Will and Emery. For those interested, we’ll have a link to that event in the show notes as well. Separate from the PPM and ASC symposium that Nick is speaking at.

Erik Sunset: You have any part to play, uh, in Value Based Care Day on Friday?

Nicholas Alarif: Just, just promoting it. Like I said, this is, um, this is a really broad topic and it means a lot of things. And, and so we have. You know, from my fraud and abuse perspective, these exceptions and safe harbors are really important for value based care, but there’s this broader, uh, kind of, um, you know, uh, uh, trends out in the industry for both managed care, [00:33:00] um, maybe, and, and risk, risk models and how these, how the shift to value based care is affecting those as well.

Nicholas Alarif: And so, uh, I think the goal of these two, two, Um, symposiums being back to back is really to cover all the different ways that, that value based care can be impacting different types of organizations, both, you know, clinics, ASEs, practices, payers, um, hospital systems. So, so, yeah, uh, that all I can say is, I think going to both and getting flavor for both will give you a really good view as to what’s, what’s happening

Nicholas Alarif: across

Nicholas Alarif: the value based care spectrum.

Erik Sunset: Yeah, you definitely end up more educated than most by attending, uh, each of these. So, value based care, obviously a hot topic. I’m not sure, though, that there’s a hotter topic in healthcare right now than that of artificial intelligence or so called artificial intelligence. What kind of thoughts, uh, do you have on the topic, [00:34:00] Nick?

Nicholas Alarif: I mean, I think it’s, it is absolutely fascinating. It is, um, I mean, I can only speak to it more from a lay person’s perspective and, uh, the impacts there, you know, some of our clients, obviously, especially in the like laboratory space, um, have been doing this for a while. Where they’ve used AI in some capacity to, to create a better mousetrap for, for, uh, diagnostic tests to predict, you know, for instance, certain types of cancers or those types of things. And so, um, I mean, where this, where this goes, how that impacts physicians and how they make decisions and how they rely on AI. Uh, and what kind of laws spring up around that in the future? You know, I think a lot of times we see the legal environment in a game of catch up kind of following the trends.

Nicholas Alarif: And so what what does that look like? Is is [00:35:00] you know, I’m just as intrigued as everybody else and how I can be leveraged in a more, uh, comprehensive capacity to Achieve better patient outcomes, I think will be interesting. And then at the end of the day, how, how that plays into fraud and abuse. Oh my God.

Nicholas Alarif: I, the, the, I have a few imaginative streams of, of how that could, could work. Um, but, but you know, that, that’s, I think for chapter chapter four or five, not even,

Nicholas Alarif: One, two or three.

Erik Sunset: Yep, I think you’re right there and I’ll call it back out. So called AI, I’ve got, um, a little bit of experience in predictive analytics and machine learning. And, you know, for those concerned, we’re headed towards like a Terminator, Skynet scenario with an uncontrolled, uh, artificial intelligence system.

Erik Sunset: We’re, we’re a ways away from that. Uh, it’s moving quickly, but we’re, we’re quite some distance away from needing to worry about things of that nature. And then what, you mentioned this too, generally, [00:36:00] uh, or historically, medicine is pretty, pretty slow to adopt. Really anything new, you know, cynically in the early days of meaningful use, you’d hear from providers that if they could, they’d still be using like a quill and a scroll papyrus to take patient notes.

Erik Sunset: What do I need an EHR for? What do I, what am I doing there? Um, historically slow, but you’re starting to see some.

Erik Sunset: Yeah. Yeah. Uh, what’s interesting to me though, is you’re starting to see some consumer protection laws be drafted and proposed around the use of AI. Still haven’t seen anything related to patient care.

Erik Sunset: So, um, I’m hopeful that we will have some forward looking folks, you know, in charge of drafting bills and laws like that, but, uh, we will see it’s moving very quickly.

Nicholas Alarif: Yeah. One can hope it’s, it’s tough to keep up with just how fast it’s developing and how quickly those, you know, those, those AI supposedly [00:37:00] is, is, uh, increasing in, in it’s, it’s, uh,

Nicholas Alarif: in

Nicholas Alarif: its eye, so to speak,

Erik Sunset: And then Nick, as we, we kind of look to put a bow on, on this one here. What would be the one thing that if you could shout it from a mountaintop that every PPM, every ASC, any physician organization, if you could just, um, send a thought out into the universe and have that be a takeaway, what do you wish everybody knew a little bit more about?

Nicholas Alarif: I mean, I think I would say Stark doesn’t have to be scary, but that’s, that’s a little personal. Like, you know, we, we can get that alignment. From a comp perspective, we can do it in a way that that works. Um, don’t and it’s always better to plan in advance. It’s easier to do things before they occur. So planning, planning and, you know, being pro proactive in how you structure some type of compensation model or equity model.

Nicholas Alarif: If we look at that at the beginning, planning, [00:38:00] We can likely get, get get you where exactly like 98 to 99 percent of what you want, maybe with a tweak here or there to, to deal with some of the regulatory constraints. Um, so, so, so getting, getting from, I’m obviously speaking from my, my little perch of, of healthcare regulatory, uh, advising, uh, getting in there early can save you a lot of heartache. Uh, at the back end. So that would be

Nicholas Alarif: my, my

Nicholas Alarif: 2 cents there.

Erik Sunset: Stark doesn’t have to be scary and an ounce of prevention worth maybe 10 pounds of cure when we’re talking about federal law. Just my opinion there. Uh, Nick, where else can folks connect with you? If you’re big on any social media.

Nicholas Alarif: Yeah, I’m, uh, I’m active on LinkedIn. That’s probably a better, I, I twi Twitter XI, I, not so much. Um, uh, you know, I [00:39:00] think, I think, uh, LinkedIn is great. So, so if people want to connect, I’m always open to to to that. And, um, again, if you’re coming down to na, we’d love to see you in Nashville. Uh, so I hope you can, can come to our panel. And stay for for the value based care symposium and if you’re into behavioral health there’s going to be a great Uh panel before before us there so so Yeah, hope hope

Nicholas Alarif: to see see folks soon

Erik Sunset: Well, I’ll, I’ll definitely make it a point to, uh, to track you down in Nashville. And if, is there anything else you want listeners to know about what you’re doing or what you have going on?

Nicholas Alarif: just uh, we’re we’re we’re busy here always, you know, there’s whether that’s transactional or just regulatory advice I would say value based care that was It’s something that we’re seeing a lot of organizations interested in looking at as avenues to, um, achieve their alignment goals. And, and so I would say keep an eye on that. [00:40:00] Um, well, we will, I think, see more and more, uh, interest generally from the, from the public on those fronts. So value based care, I’m all, I’m all about it. And I think, I think folks, even if they don’t think that they’re part of, part of value based care, you absolutely can be. Uh, and what you’re doing can be so, um, that would

Nicholas Alarif: be

Nicholas Alarif: my last thoughts there.

Erik Sunset: Well put Nick, thanks for the time. Really appreciate you joining the show today.

Nicholas Alarif: Yeah, the other thing I’ll note is, um, if folks are interested in, in getting, uh, keeping abreast of legal developments, we’re seeing a lot of changes, uh, both at a state, uh, level from a, um, a, um, I’m sure folks have been listening to the non compete talk coming out of the FTC, uh, maybe of interest to folks. Uh, a lot of changes at the state level from a corporate practice of medicine perspective, a lot of interest generally about, uh, private equity at, at [00:41:00] both the federal and state level and their involvement in health care. We are doing as a firm a whole lot of, uh, webinars. Uh, in addition to the symposiums that we’re doing in Nashville, and a lot of, uh, thought leadership articles on different subjects as they come out.

Nicholas Alarif: So I’d also recommend folks, uh, click a follow on McDermott, McDermott Health. Generally, not just me, but all my wonderful colleagues are doing great work on this space. I think we’re doing like, we’re following a lot of 340B developments as well. Everything you can think of on the topic of healthcare developments, our firm does a really great job of keeping the public informed of those happenings.

Nicholas Alarif: So, uh, please, please,

Nicholas Alarif: look into that as well.

Erik Sunset: We’ll be sure that everything that we’ve referenced in this episode, the PPM and ASE symposium, the value based care symposium, the, the link that Nick just referenced there. We’ll make those all clickable in the show notes. They’ll be, they’ll be easy to track down [00:42:00] for listeners to engage with and follow and soak up as much information as they can.

Erik Sunset: And on behalf of the entire DocBuddy team, I want to thank you for listening. Be sure you’re subscribed to DocBuddy on Apple Podcasts, so you can always get the newest episodes of the show. Until next time, I’m your host, Erik. We’ll talk to you soon.