John A. Anderson

John Anderson Speaking in Live Webinar Stark Law Regulations: Significance to Your Firm

Giarmarco, Mullins & Horton, P.C. is pleased to announce that John Anderson will be a speaker for the Live Webinar assembled by The Knowledge Group titled, CMS Final Rule Modifying the Stark Law Regulations: Significance to Your Firm Explored! The Centers for Medicare and Medicaid Services have recently published the final CY 2016 Physician Fee Schedule rule. This rule modifies the Physician Self-Referral Law (Stark Law), and sets in stone new exceptions for Recruitment of Non-Physician Practitioners (NNPs).

The webinar is a review of the Physician Self-Referral Law, significant modifications and new exceptions, key regulatory considerations and challenges. Mr. Anderson will be breaking the rule into easy to understand sections and discussing the legal risks and traps of the modification.

Participants that would benefit from the webinar include organizations, finance executives and service providers; as well as hospital executives, medical directors, health insurance companies and finance lawyers. To register for the Live Webinar and to receive more information, please visit: http://ow.ly/108xca.

John Anderson is co-chair of the healthcare practice group at the law firm of Giarmarco, Mullins & Horton, P.C. in Troy, Michigan. He represents physicians, group practices, ancillary providers, Accountable Care Organizations, clinical labs and hospitals, among others. He regularly helps clients navigate regulatory issues and structures business arrangements in the constantly evolving healthcare environment. He’s the former Board Chair of Genesys Hospital in Grand Blanc, Michigan and he currently sits on the Board of Trustees for Ascension Health, Michigan where he also chairs the Quality & Safety Committee for that state-wide Board. John also sits on the Board of Directors of the Genesys Physician Hospital Organization, which operated one of the original Pioneer Accountable Care Organizations and which currently operates a Shared Savings Plan ACO.

ACOS: Here To Stay Or Gone Tomorrow?

It’s an understatement to say that there is still much skepticism surrounding Accountable Care Organizations.  The ACO program was launched by the Centers for Medicare and Medicaid Services, (“CMS”) in January, 2012 when 32 “Pioneer” ACOs commenced operation.  In April of 2012, 27 new Medicare Shared Savings Program ACOs were announced, followed by 88 more ACOs in July, 2012 and finally 106 new ACOs were added in January of this year as the ACO program continued ramping up.  As a consequence, CMS estimates that more than 4 million Medicare beneficiaries nationwide currently have access to medical care through ACOs.  A recent Oliver Wyman press release states that ACOs now serve 14% of all Americans, with more than half of the U.S. population now living in localities served by ACOs.  The numbers are increasing rapidly and the program has been in operation for less than 18 months.  Commercial plans modeled after ACOs, such the Blue Cross Organized Systems of Care, will make these numbers even larger. “Get On Board Or Get Left Behind” is a theme repeatedly heard from health care consultants.

Yet, a February 18, 2013 Wall Street Journal Op-Ed piece trumpeted “The Coming Failure of Accountable Care,” and a recent survey of 1,200 physicians by Locum Tenans.com revealed that 40% of respondents said they would not be willing to participate in an accountable care arrangement.  The view of many health care providers regarding ACOs ranges from “wait and see” to deep skepticism.  Some believe that ACOs are simply the latest iteration of the 1990s HMO and are doomed to failure.  What is the correct view?  Is the ACO here to stay, or will it be gone tomorrow?

Abundant evidence supports the view that the ACO model will be with us into the foreseeable future.  Why?  You’ve heard it before, but it bears repeating: the current health care spend in the United States is not sustainable—it hovers at around 18% of GDP today and Kaiser Health News reports that it is projected to reach about 20% of GDP by 2021. Multiple trends are gaining momentum simultaneously to address this problem: the shift away from fee-for-service to fee-for- results; the rise and spread of population health management by which providers take responsibility for a “population” of patients and assume the risk for their care; the resulting need for consolidation and growth in market share as providers seek more “covered lives” to spread the risk; the drive toward greater clinical integration among providers as a means of developing and disseminating improvements in clinical pathways and evidence-based medicine to improve quality and reduce cost.  On the near horizon is Medicaid expansion and the Health Care Exchange in 2014.  The small private provider is particularly at risk in this “new world” of health care, but all providers must find a way to address these challenges.  There is strength in numbers and size and mission alignment, and the ACO model provides a vehicle to achieve those objectives.

Without question, some ACOs will fail.  For example, a tectonic shift in the culture of health care providers will be needed and it remains to be seen whether that shift can occur and, if so, whether it can occur fast enough to impact sufficiently the urgent problem of increasing costs.  But the ACO model is a means to that end.  However, it’s about much more than just shared savings.  It’s about reducing cost and improving quality and enhancing the patient experience.  The ACO shared savings are the incentive to help us reach those larger goals.

John A. Anderson is a member of the Business Practice Group of Giarmarco, Mullins & Horton, P.C., where he concentrates his practice in health care law and banking.  He is Vice Chairman of the Board of Trustees for Genesys Health System in Grand Blanc, Michigan, has also chaired the health system’s Quality & Safety Committee, and serves on the Board of the Genesys PHO.  For more information, you may contact him directly at (248) 457-7182 or janderson@gmhlaw.com.

John Anderson recognized By Martindale Hubbell as Best Lawyer in America 2013

John Anderson is the Co-Chair of the Health Care Practice Group at Giarmarco, Mullins & Horton, P.C., representing numerous health care providers ranging from large single and multi-specialty groups to small groups and individual physicians. He also represents diagnostic providers, physical therapy providers, and home health agencies. He has considerable experience as a business lawyer representing both middle-market clients and entrepreneurs, with a main focus of his practice is in health care law, primarily on the provider side.

He also has vast experience working with banks, particularly in relation to loan workouts, special asset issues, forbearance agreements and foreclosures, as well as the civil and bankruptcy litigation related to such workout matters.

Mr. Anderson’s practice areas include all manner of business transactional and litigation matters, with an emphasis on banking and health care law and the full spectrum of health care provider issues including compliance matters, fraud & abuse, third-party audits, billing & reimbursement, entity formation, contract negotiations, physician self- referral/Stark, Anti-kickback, licensing and litigation.

Mr. Anderson is an adjunct professor of Management at Walsh College, teaching in their MBA program.

Honors and awards include:  “AV” Peer Review Rating from Martindale-Hubbell, the highest ranking by peers for general ethical standards and legal ability; U.S. News – Best Lawyers 2013; dbusiness Top Lawyer 2012.  Inclusion in Best Lawyers is considered a singular honor.

Leadership positions include:  Genesys Regional Medical Center (GRMC)– Executive Committee and Board Vice-Chair, Physician Hospital Organization – Board Member;  Michigan State Bar – Business Law Section;  American Health Lawyers Association;  Michigan State Bar: Health Care Law Section (HCLS) – Member of that Section’s Governing Council;  HCLS Publications Committee – Former Co-Chair;  and HCLS Health Providers Subcommittee – Former Member.

Giarmarco, Mullins & Horton, P.C. (www.gmhlaw.com), ranks as the 12th largest law firm in Michigan.  Founded 39 years ago, located in Troy and Detroit, Michigan.  It is a full service law firm with 70 attorneys.  Areas of practice include litigation, corporate law, health care law, business transactions, estate and trust planning, commercial litigation, governmental law, real estate, creditors’ rights, criminal law, employment and labor and workers’ compensation.  GMH has been recognized as a Top Tier Law Firm in the United States by U.S. News and World Report.  Additional recognitions include Crain’s Detroit Business Cool Place to Work and Detroit Free Press Top Workplaces 2012.