Healthcare Track

Regulatory Overview for Valuation Professionals

Monday, August 3
11:45 a.m.–1:25 p.m.
2 hours CPE
Since the 2010 passage of the ACA, providers are facing increased regulatory scrutiny, much of which attention is focused on the strict prosecution of fraud and abuse violations, in part, as an avenue to help finance the ACA.  The sweeping nature of the ACA will continue to drive ongoing changes in the structure, operation, and financing of many healthcare provider enterprises, likely resulting in an even further increase in hospital/physician practice integration/transactional activities, as well as an increase in the number of U.S. physicians that are currently employed by hospitals. This Session will present an overview of the healthcare industry’s regulatory environment and will explore the framework through which the interplay between the various federal and state laws within the U.S. healthcare delivery system interact within the context of fraud and abuse regulation and enforcement; tax regulations; licensure and accreditation; competition laws; privacy laws; other federal regulations; and, the ACA.

**This will be a replay of the recorded session from the June Conference. Presenters Todd Zigrang and Jessica Bailey-Wheaton will be "live" in the Q&A box located in the Zoom toolbar to answer any questions during the session. You still need to answer all poll questions that are launched throughout the presentation to earn CPE.**

After completing this session, attendees will be able to:

• Recognize tax regulations as they relate to tax-exempt healthcare organizations and their employees, as well as provider taxes, ad valorem taxes, and excise, sales, and use taxes, and how they impact the valuation of a healthcare organization
• Identify the healthcare fraud and abuse laws, including the Anti-Kickback Statute, the Stark Law, and the False Claims Act, as well as the regulatory bodies that enforce them
• Describe the thresholds of fair market value and commercial reasonableness

Total CPE: 2 hour(s)
Field(s) of Study: Business Law—1 hour; Regulatory Ethics—1 hour

Who Should Attend:

Legal professionals and healthcare providers, as well as those valuation professionals wishing to expand their scope of activities in healthcare valuation engagements and those seeking to enhance their current healthcare valuation service lines.

Program Level and Prerequisites:

Basic: Learning activity level most beneficial to individuals new to a skill or an attribute.

Advanced Preparation:

None

Todd Zigrang

Todd  Zigrang

Read Biography

The Due Diligence Imperative in the Era of Value-Based Reimbursement

Monday, August 3
1:40 p.m.–2:30 p.m.
1 hour CPE
With the emergence of value-based reimbursement models, which rely on achieving the “Triple Aim” of healthcare at lower cost, healthcare providers are increasingly looking to change how services are being delivered by seeking more collaborative relationships with physicians. The increase in these alignments to address value-based reimbursement initiatives has led to a growing number and complexity of transactions in the healthcare delivery marketplace, accompanied by increased federal and state regulatory scrutiny regarding the legal permissibility of these arrangements. Therefore, now more than ever, conducting a level of due diligence appropriate to the scope and complexity of a given assignment is critical to the transactional risks (financial, operational, and regulatory) that may impact the development and defensibility of the valuation opinion. This session will discuss the due diligence process of a healthcare transaction within the Four Pillars of Healthcare Valuation, i.e., regulatory, reimbursement, competition, and technology.

**This will be a replay of the recorded session from the June Conference. Presenters Todd Zigrang and Jessica Bailey-Wheaton will be "live" in the Q&A box located in the Zoom toolbar to answer any questions during the session. You still need to answer all poll questions that are launched throughout the presentation to earn CPE.**

After completing this session, attendees will be able to:

• Describe the regulatory and compliance issues arising from healthcare transactions that are necessitating the increased importance of the due diligence process
• Define the two distinct classes of information required for the due diligence and explain its applicability to the healthcare valuation process
• Identify sources of information that will allow for the appropriate level of analysis required of a transaction in the changing healthcare industry and of the development of a credible valuation opinion

Total CPE: 1 hour(s)
Field(s) of Study: Economics—1 hour

Who Should Attend:

Legal professionals and healthcare providers, as well as those valuation professionals wishing to expand their scope of activities in healthcare valuation engagements and those seeking to enhance their current healthcare valuation service lines.

Program Level and Prerequisites:

Basic: Learning activity level most beneficial to individuals new to a skill or an attribute.

Advanced Preparation:

None

Todd Zigrang

Todd  Zigrang

Read Biography

Jessica Bailey-Wheaton

Jessica  Bailey-Wheaton

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The Valuation of Healthcare Enterprises in a Changing Reimbursement Environment

Monday, August 3
3:30 p.m.–5:10 p.m.
2 hours CPE
Valuation professionals advising healthcare industry individuals and entities should develop and maintain an in-depth understanding of current and future trends related to the U.S. healthcare reimbursement environment, particularly in an era of healthcare reform. Such trends, such as the transition from volume-based to value-based reimbursement, have the potential to change the way reimbursement is provided and significantly affect provider compensation. This Session will discuss healthcare reimbursement within the context of how most providers receive reimbursement for their services from third parties, including: (1) government agencies; (2) commercial payors and insurance companies; (3) employers; and, (4) patients and their families. The Session will also explore the healthcare revenue cycle and emerging reimbursement trends.

**This will be a replay of the recorded session from the June Conference. Presenters Todd Zigrang and Jessica Bailey-Wheaton will be "live" in the Q&A box located in the Zoom toolbar to answer any questions during the session. You still need to answer all poll questions that are launched throughout the presentation to earn CPE.**

After completing this session, attendees will be able to:

• Create an outline of the steps of the healthcare revenue cycle and describe the applicability of those steps in the current reimbursement environment
• Identify the types of public and private payors, as well as the methods of reimbursement that currently exist and are likely to exist going forward
• Recognize the impact of healthcare reform as to the reimbursement methods utilized by emerging healthcare organizations such as accountable care organizations and patient-centered medical homes

Total CPE: 2 hour(s)
Field(s) of Study: Economics—1 hour; Finance—1 hour

Who Should Attend:

Legal professionals and healthcare providers, as well as those valuation professionals wishing to expand their scope of activities in healthcare valuation engagements and those seeking to enhance their current healthcare valuation service lines.

Program Level and Prerequisites:

Basic: Learning activity level most beneficial to individuals new to a skill or an attribute.

Advanced Preparation:

None

Todd Zigrang

Todd  Zigrang

Read Biography

Stark Law Modernization—The Healthcare Valuation Implications

Monday, August 3
5:25 p.m.–6:15 p.m.
1 hour CPE
On October 9, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to modernize and clarify the Stark Law. These proposed rule changes have potentially significant implications, and may serve to create additional opportunities for healthcare valuation professionals, with CMS recognizing and confirming the close link between “the regulated [healthcare] industry and its complementary parts, such as the health care valuation community...” This Session will summarize the Stark Law proposed rule in brief; discuss CMS’s proposed to changes to the definitions of Fair Market Value and Commercial Reasonableness; and, review the potential implications of these rule changes on healthcare valuation.

**This will be a replay of the recorded session from the June Conference. Presenters Todd Zigrang and Jessica Bailey-Wheaton will be "live" in the Q&A box located in the Zoom toolbar to answer any questions during the session. You still need to answer all poll questions that are launched throughout the presentation to earn CPE.**

After completing this session, attendees will be able to:

• Identify the differences between the current Fair Market Value definition and the proposed definition
• Describe the two proposed definitions of Commercial Reasonableness
• Explain potential implications of the Stark Law proposed rule on healthcare valuation

Total CPE: 1 hour(s)
Field(s) of Study: Business Law—1 hour

Who Should Attend:

Legal professionals and healthcare providers, as well as those valuation professionals wishing to expand their scope of activities in healthcare valuation engagements and those seeking to enhance their current healthcare valuation service lines.

Program Level and Prerequisites:

Update: Learning activity level that provides a general review of new developments.

Advanced Preparation:

None

Todd Zigrang

Todd  Zigrang

Read Biography

Jessica Bailey-Wheaton

Jessica  Bailey-Wheaton

Read Biography

Competitive Forces in the Healthcare Industry

Tuesday, August 4
12:05 p.m.–1:45 p.m.
2 hours CPE
Valuation professionals should develop and maintain an in-depth understanding of the historical development, as well as current trends related to, the competitive forces impacting the U.S. healthcare delivery system. The last two decades have seen the accelerated transformation of the U.S. healthcare professions into a service industry enterprise, whereby health services have been unitized, protocolized, and homogenized, in order to facilitate their sale in the market, just as if they were any other fungible market commodity. These changes have accelerated the “corporatization” of medicine, as demonstrated by the increase in for-profit hospitals, outpatient/ambulatory facilities and large for-profit health insurance payors. This Session will present an overview of the current U.S. healthcare competitive marketplace; the economics driving healthcare, including supply and demand; the impact of government regulation; barriers to free market competition in healthcare delivery; and, historical reform efforts and their effect on competition.

**This will be a replay of the recorded session from the June Conference. Presenters Todd Zigrang and Jessica Bailey-Wheaton will be "live" in the Q&A box located in the Zoom toolbar to answer any questions during the session. You still need to answer all poll questions that are launched throughout the presentation to earn CPE.**

After completing this session, attendees will be able to:

• Recognize the economic principles underlying the U.S. healthcare competitive environment
• Describe Porter’s Five Forces of Competition as they relate to the healthcare industry, and why healthcare is different from other industries
• Identify the barriers to free market competition in healthcare and understand the reasons they exist, as well as the effects that these barriers have on quality and outcomes

Total CPE: 2 hour(s)
Field(s) of Study: Behavioral Ethics—2 hour(s)

Who Should Attend:

Legal professionals and healthcare providers, as well as those valuation professionals wishing to expand their scope of activities in healthcare valuation engagements and those seeking to enhance their current healthcare valuation service lines.

Program Level and Prerequisites:

Basic: Learning activity level most beneficial to individuals new to a skill or an attribute.

Advanced Preparation:

None

Todd Zigrang

Todd  Zigrang

Read Biography

Development of a Commercial Reasonableness Opinion

Tuesday, August 4
2:45 p.m.–3:35 p.m.
1 hour CPE
Commercial reasonableness, a threshold that is related to, but distinct from, fair market value, has emerged as a focus of regulatory scrutiny for healthcare transactions. The Session will focus on the elements of the qualitative and quantitative analysis undertaken to meet the applicable regulatory pronouncements required for establishing commercial reasonableness, as well as the interplay between fair market value and commercial reasonableness in healthcare transactions. Further, this Session will present a case study of an exempt healthcare organization—a cardiac clinic—and will provide step-by-step guidance about addressing each of the thresholds of commercial reasonableness as it applies to healthcare transactions involving healthcare enterprises, assets, and services.

**This will be a replay of the recorded session from the June Conference. Presenters Todd Zigrang and Jessica Bailey-Wheaton will be "live" in the Q&A box located in the Zoom toolbar to answer any questions during the session. You still need to answer all poll questions that are launched throughout the presentation to earn CPE.**

After completing this session, attendees will be able to:

• Analyze the transactional prerequisites of commercial reasonableness
• Explain the steps required to perform a qualitative analysis
• Explain the steps required to perform a quantitative analysis

Total CPE: 1 hour(s)
Field(s) of Study: Economics—1 hour

Who Should Attend:

Legal professionals and healthcare providers, as well as those valuation professionals wishing to expand their scope of activities in healthcare valuation engagements and those seeking to enhance their current healthcare valuation service lines.

Program Level and Prerequisites:

Intermediate: Learning activity level that builds on a basic program most appropriate for individuals with detailed knowledge in an area.

Advanced Preparation:

None

Todd Zigrang

Todd  Zigrang

Read Biography

Jessica Bailey-Wheaton

Jessica  Bailey-Wheaton

Read Biography

Technological Advancements in the Healthcare Industry

Tuesday, August 4
3:50 p.m.–5:30 p.m.
2 hours CPE
Technology has a broad meaning when applied to the healthcare delivery system. It can range from the tangible tools, pharmaceuticals, and software that providers use during the provision of clinical services to the management of patient records to the procedures that constitute the standardized Session of care. Technology-driven change is constantly pushing back the barriers of medicine, with diagnostic and therapeutic clinical technologies continuing to emerge, replacing outdated techniques with less invasive, yet more expensive, alternatives.  Additionally, with growing importance placed on the value metrics of patient care, i.e., “highest quality at lowest costs,” an integrated management information technology system that includes data input by the patient, the provider, and the payor, may enhance the communication between these stakeholders and improve the continuum of care. This Session will explore both the clinical and management technologies of the current healthcare technological environment.

**While other sessions in this Healthcare track were replays from June conference, this will be a "live" session with the presenters.**

After completing this session, attendees will be able to:

• Describe the history of healthcare information and management technology, and how it exists as a process
• Evaluate the different types of clinical technology and apply them to valuation issues in the U.S. healthcare industry
• Explain how operational management concerns relate to patient safety and privacy considerations in healthcare

Total CPE: 2 hour(s)
Field(s) of Study: Information Technology—2 hour(s)

Who Should Attend:

Legal professionals and healthcare providers, as well as those valuation professionals wishing to expand their scope of activities in healthcare valuation engagements and those seeking to enhance their current healthcare valuation service lines.

Program Level and Prerequisites:

Basic: Learning activity level most beneficial to individuals new to a skill or an attribute.

Advanced Preparation:

None

Todd Zigrang

Todd  Zigrang

Read Biography

Jessica Bailey-Wheaton

Jessica  Bailey-Wheaton

Read Biography

Valuation Implications of COVID-19

Tuesday, August 4
5:45 p.m.–6:35 p.m.
1 hour CPE
The COVID-19 global pandemic has brought a time of grave uncertainty for U.S. healthcare and the greater economy. Both the legislative branch and the executive branch of the federal government have taken a number of unprecedented actions in an effort to stem the effects of the pandemic. Consequently, the uncertainty surrounding the resulting paradigm changes on the U.S. healthcare industry, as well as the greater U.S. economy, may have lasting and significant implications on the valuation of healthcare enterprises, assets, and services—both now and in the future.

**While other sessions in this Healthcare track were replays from June conference, this will be a "live" session with the presenters.**

After completing this session, attendees will be able to:

• Recognize the various ways in which the COVID-19 pandemic has changed the U.S. healthcare industry
• Identify the various measures taken by the federal government (and to some extent, state governments) to reduce the burden on the U.S. healthcare industry
• Articulate the potential impact that the COVID-19 pandemic may have on the valuation of healthcare enterprises, assets, and services

Total CPE: 1 hour(s)
Field(s) of Study: Economics—1 hour

Who Should Attend:

Professionals interested in valuation implications of COVID-19

Program Level and Prerequisites:

Update: Learning activity level that provides a general review of new developments.

Advanced Preparation:

None

Todd Zigrang

Todd  Zigrang

Read Biography

Daniel Chen

Daniel  Chen

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