Media Mentions
2012
“Industry Insiders Clarify MSSP Participation in Multiple ACOs”
ACO Business News, January 2012
J. Peter Rich said that under final Medicare rules for accountable care organizations (ACOs), a primary care physician’s taxpayer ID number (TIN) “must be exclusive to one ACO (and will determine the Medicare beneficiaries attributed to that ACO).” Mr. Rich added that a physician could theoretically participate in a second ACO by billing under the TIN of a medical group, practice association or hospital.
2011
“Appeals Court Strikes Health Insurance Requirement”
Associated Press, August 13, 2011
J. Peter Rich noted that, despite rulings by lower courts, the U.S. Supreme Court has not ruled on the “specific issue” of the health reform law’s provision requiring individuals to buy health insurance. Mr. Rich said it is not unconstitutional for individual states like Massachusetts to have such a provision, but the federal requirement “really is a case of first impression, although the Obama administration may try to argue otherwise.”
“Eleventh Circuit Rules Individual Mandate Is Unconstitutional”
Blog of Legal Times, August 12, 2011
J. Peter Rich predicted that the U.S. Justice Department will have “a tough decision to make” on whether to have the full Eleventh Circuit review a three-judge panel’s rejection of the health reform law’s mandatory insurance provision, because the full court could strike down the entire law. Even so, Mr. Rich said he expects the U.S. Supreme Court to wait until the Fourth Circuit rules before taking the issue up.
“Supreme Court Rejects Fast-Track Health Care Appeal”
Law360, April 25, 2011
J. Peter Rich stated that the US Supreme Court’s refusal to make an early review of challenges to the health care reform law “does not lead to the conclusion that the court will eventually uphold the constitutionality of the individual [coverage] mandate or even of the health reform law as a whole.” But he added that if the court later overturns the entire law, its decision “will have an even more profound impact because the law would then be much farther down the road in its implementation.”
“Should Specialists Join ACOs?”
Becker’s Hospital Review, April 12, 2011
J. Peter Rich warned that if procedure-oriented specialists do not join hospital accountable care organizations, “the primary care physicians in the ACO could shift the specialist’s referrals to someone else.” Mr. Rich said that an ACO formed with private payors could require contracts that would spell out the specialist’s obligations and the way payments would be distributed, while adding that not all specialists would have contracts.
J. Peter Rich, Accountable Care Organization Resource Center, Health
“Health Care Ruling Raises New Question for High Court”
Law360, February 1, 2011
Peter Rich held that court rulings in Florida and Virginia that the health reform law’s individual insurance mandate is unconstitutional, with the Florida court saying that the mandate invalidated the entire law, makes it likely that the Supreme Court will rule sooner on the issue. As he explained, if the individual mandate, which is effective in 2014, cannot be severed from the law as the Virginia court held, the Supreme Court will want to rule on the entire law so that the government does not have to unwind provisions implemented earlier. Mr. Rich added that if only the mandate is struck down, “that is the beginning of the end for the individual health insurance market as far as private insurance companies are concerned.”
“The Health Care Ruling: The Experts Speak”
Wall Street Journal, January 31, 2011
Peter Rich made this prediction if the Supreme Court adheres to either of two district court rulings that the health reform bill and/or its individual coverage mandate are unconstitutional:
“We are likely to see a mass exodus of private health insurance carriers from the individual insurance market – particularly if there is an acceleration of the trend among state insurance regulators to try to block premium increases…. The ‘Affordable Care Act’ would then have perversely made health insurance not only affordable but unobtainable for the increasing number of Americans who have no access to either group health insurance or governmental health programs.”
J. Peter Rich, Accountable Care Organization Resource Center, Health
2010
“Attorney Says AMA’s Principles for ACOs Noncontroversial, but Could Use Tweaking”
BNA’s Health Law Reporter, December 2, 2010
J. Peter Rich called the American Medical Association’s principles for developing accountable care organizations in accord with the health reform act “pretty uncontroversial” because they affirm the “consensus that physicians will play a primary role in ACO governance.” However, he criticized the AMA’s call to separate ACO and hospital boards, saying, “As a practical matter, it is unlikely an ACO-member hospital will consent to governance by a board that does not include any of its board members.” He also cited the lack of guidance on encouraging patients to remain in an ACO, saying that will make substantial cost savings “difficult if not impossible.”
J. Peter Rich, Health, Managed Care
“How far can providers go? | Regulators grapple with antitrust, fraud-and-abuse issues under reform”
Modern Healthcare, September 20, 2010
J. Peter Rich addressed the health care reform law’s implications for Accountable Care Organizations (ACOs). The law requires Medicare to reward providers that work together in ACOs to improve care, but Mr. Rich asserted that “I’m not sure there are any answers” to the antitrust and fraud-and-abuse issues raised by such collaboration. He noted that many providers are holding off on ACO participation, and added: “There are a lot of question marks here. Everybody’s excited about doing something, but they’re waiting to see what that something is.”
2009
J. Peter Rich spoke at length to HealthLeaders Media on September 15 regarding disruptive physician treatment of staff members. "In some cases the physicians are good at dealing with patients," he noted, "but when it comes to staff they can't keep their temper and they don't know how to treat people properly." Mr. Rich recommends that provider organizations hiring new physicians do a full due diligence screening of their past work history for signs of disruptive behavior. "It's easier to keep out a disruptive physician than to keep one out," he asserted. He also recommended writing into physician contracts that failure "to act in a civil manner toward colleagues, patients and others" is grounds for termination. Should there be disruptive behavior, Mr. Rich advised creating signed, dated documentation of it. "If this is a pattern that needs to be dealt with, it is important to have a paper trail," he said.
2002
Terese A. Mosher-Beluris and J. Peter Rich were quoted extensively in the cover feature of the September issue of Managed Care Contracting & Reimbursement Advisor. Ms. Mosher-Beluris and Mr. Rich addressed how a provider can lessen the risk of unpaid claims when treating members through a provider organization. Ms. Mosher-Beluris discussed a case in which the Firm obtained a $2.6 million judgment for a hospital, after a health plan refused payment based on its contract with an intermediary organization to pay those claims. Mr. Rich explained the importance of a provider obtaining a direct relationship with a plan if the provider is to get a court or arbitrator to order a plan to pay it once the intermediary provider organization fails to pay. They both also discussed ways that critical provider-plan relationship could be established.
Terese A. Mosher Beluris, J. Peter Rich, Health, Managed Care
