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Strategic considerations and transaction trends

Navigating primary care partnerships

Primary care is at the top of the list for investors. Here are factors for physicians to consider when engaging with potential partners.

Navigating primary care partnerships: strategic considerations and transaction trends

Primary care continues to be a target for investors

Why so many physicians are partnering with private equity

Commercial payers, large employers and leading provider systems across the nation have fully embraced this transformation and they will not simply revert back to the fee-for-service system of healthcare delivery and reimbursement.

Despite White House shake-up, value-based pay is here to stay

End-to-end partnerships are defined differently across revenue cycle management (RCM) vendors. Recently, some RCM vendors have shifted their focus to technology-only solutions, whereas others have made external partnerships their sole priority. Our experience at Optum tells us that cultivating the appropriate and optimal combination of people, processes and technology will remain a critical driver of RCM success.

Whether you're a small practice looking to enhance your revenue cycle or a larger organization seeking to optimize existing processes, this article will provide you with valuable knowledge and actionable steps to unlock success in physician revenue cycle management.

Fill out the form below to download the article.

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The 3 Pillars of Physician Revenue Cycle Management: People, Process, and Technology

 that shifts the focus from the volume of services provided to the quality of care delivered. This paradigm shift aims to improve patient outcomes, reduce costs, and enhance the overall efficiency of the health care system. 

, as one of the largest health care payers in the United States, has played a pivotal role in implementing VBC initiatives.

One of the key advantages of VBC for Medicare is its potential to reduce health care costs. By 

 to deliver high-quality care efficiently, VBC can help curb unnecessary procedures, hospitalizations, and other costly medical interventions. This can lead to significant savings.

Another important benefit of VBC is its emphasis on improving patient outcomes. By focusing on quality rather than quantity, VBC encourages providers to deliver personalized care that addresses the specific needs of each patient. This can create positive health outcomes, increased patient satisfaction, and reduced readmission rates.

Medicare has implemented various VBC programs, including 

 (ACOs), bundled payments, and Comprehensive Primary Care Plus (CPC+) models. ACOs have gained significant traction as they bring together providers and hospitals to coordinate care and share in the financial risks and rewards.

While VBC has shown promising results, challenges remain. Implementing VBC requires a significant cultural shift within the health care industry, as it necessitates a move away from fee-for-service models. Additionally, there are concerns about the potential for disparities in care quality among different patient populations.

Value-based care represents a significant step forward in transforming the Medicare program. It has the potential to deliver substantial benefits to both beneficiaries and the health care system. As Medicare continues to expand and refine its VBC initiatives, it is crucial to address the challenges and capitalize on the opportunities to create a more sustainable and patient-centered health care system. To learn more, look at this slideshow created from an Aledade infographic.

Ahmed Haque leads Network Performance & Strategy at

, overseeing performance and shared savings across Accountable Care Organizations. He has 15+ years in healthcare, previously working at the U.S. Department of Health & Human Services, National Quality Forum, and the American Hospital Association.

Incentivizing high-quality care reduces costs while improving patient outcomes.

Topics

Value-based care: Transforming Medicare for the better

5 marketing tips for busy doctors

Medical practices are undeniably busy places. Physicians have incredibly limited time, and administrative staff often juggle multiple roles. Despite this, attracting new patients, enhancing the experience for current patients, and improving brand perception are more crucial than ever. 

 is essential for any business, and medical practices are no exception.

Yet, many medical practice owners and administrators are reluctant to manage marketing campaigns on their own due to time constraints or lack of familiarity with promotional strategies. The familiar phrase, “you don’t know what you don’t know,” rings especially true here, as it’s often impossible to know where to start with marketing or public relations if you are a novice. With search engines and artificial intelligence tools, it may be incredibly easy to search for “how” to do something, but it’s often the “why,” “where,” and “when” that elude us when first starting a new discipline.

That’s where do-it-yourself (DIY) medical marketing platforms come in. Rather than investing in an experienced, in-house marketing team or partnering with an external PR or advertising agency, a medical practice should consider leveraging a DIY platform to think like a marketer and take those crucial first steps.

The common refrain, "But who has time for marketing?" is often heard. The reality is, if you can find a few minutes to check your personal social media or read up on the latest sports news, you can find the time to enhance your medical practice's growth, financial stability, and reputation. Using step-by-step blueprints from a DIY marketing tool, you and your team can attract new patients, engage better with existing ones, and elevate your practice.

, a consulting firm that delivers do-it-yourself (DIY) promotional tools, resources, and guidance for those who are not experts in marketing communications.

In the fast-paced environment of medical practices, effective marketing is crucial for attracting new patients and enhancing brand perception. Many practice owners and administrators hesitate to manage marketing due to time constraints and unfamiliarity with strategies. DIY medical marketing platforms offer a solution, enabling practices to take initial marketing steps without hiring an in-house team or agency. By dedicating small amounts of time, practices can utilize these platforms to improve growth, financial stability, and reputation. Tom Testa's firm, Owned Reputation, provides DIY promotional tools and guidance for non-experts.

These tips can help you develop a DIY marketing plan for your practice.

Primary care physicians (PCPs) traditionally collect blood for diagnostics instead of for lifesaving transfusions. But they could play a far more significant role when it comes to helping blood centers build and maintain their blood supply.

The aging population, declining birth rates, and fewer young and first-time donors in the United States have made 

 more pronounced. While regenerative medicine and the ability to create artificial sources of blood might be on the far horizon, they are not yet achievable on a scale necessary for transfusions, making the role of PCPs in promoting blood donation even more vital to supporting the country’s blood supply.

To illustrate the severity of the issue, donations from young people have declined by nearly 50% post-COVID-19, posing a long-term threat to the stability of the nation’s blood supply. And younger people are critical to replace the older donors who are aging out of the donor pool. Historically, donations from 16- to 24-year-olds accounted for 25% of the country’s blood supply, but they now account for only about 

. In addition, there have been fewer workplace-organized drives post-COVID-19 due to remote and hybrid work schedules, which has also led to a decline in donations. Of the total U.S. population, 62% are eligible to donate, yet only 3% do.

While it is no secret that blood donations are critical, it’s easy to overlook just how important they are for the broader health of our communities and how much of a role blood transfusions play in the daily lives of those around us. Blood transfusions are essential for a variety of medical procedures and emergencies, including accidents and major surgeries, cancer treatments, chronic diseases and childbirth. These wide-ranging applications in life-threatening situations underscore the indispensable role of blood donations in modern medicine.

Blood also has a short shelf life, meaning hospitals require constant replenishment to meet patient needs. With no substitute for blood as of yet, those requiring blood transfusions rely solely on volunteer donors, making it essential for the health of all individuals across the globe and all the more necessary for PCPs to play their part in educating and encouraging their eligible patients to donateblood.

Not-for-profit blood centers like New York Blood Center Enterprises (NYBCe) are dedicated to maintaining a steady supply of blood for communities in New York and across the United States. Through its operating divisions located on the East Coast and throughout the Midwest, NYBCe annually delivers 1 million blood products to more than 400 hospitals nationwide and provides additional medical and consultative services to more than 200 research, academic, and biomedical organizations globally. Thanks to recent support from the public markets and a dedicated team of J.P. Morgan health care bankers, we raised $46 million to fund the transformation of a new facility in Rye, New York. Upon completion, the Rye NYBCe facility will enable us to continue our life sciences research, blood collections, processing, distribution and cell therapy manufacturing side by side, and welcome both existing and first-time donors to a comfortable new space. But we can’t do this alone.

Partnership with PCPs is crucial to enhance awareness by 

 about the importance of blood donation and encouraging them to engage in this lifesaving work. Encouragement from a patient’s PCP can go a long way toward understanding the value and ease of donating blood. Additionally, PCPs can display blood donation collateral in their practice office and exam rooms, including informational material like pamphlets, brochures and posters provided by NYBCe. Providing encouraging reminders and increasing accessibility is an essential step in increasing donations. For example, J.P. Morgan has hosted on-site quarterly blood drives in partnership with NYBCe for over two decades, making it easy for employees to donate during the workday. Since 2016 alone, these blood drives have facilitated 3,000 blood donations.

During times of crisis or blood shortages, PCPs can also spread awareness to their patient base through email or other communications about the need for donations, highlighting the urgency and reasons blood donations are vital in keeping their communities healthy and safe. Even outside times of crisis, they can initiate meaningful conversationsaround the importance of blood donation with their patients and within their community. An effective way to actively promote blood donation is by sharing content on their practice’s website and social media channels — especially highlighting real-life, close-to-home stories where blood donations have saved lives.

Spreading awareness is key to creating a culture of regular blood donation, which can help save lives and fuel innovation. By helping to create an environment where giving blood is seen as a routine and essential act of community care, PCPs can help ensure that hospitals and medical facilities are well equipped to handle emergencies, surgeries and treatments that rely on blood transfusions. Together, through consistent encouragement and education, we can all contribute to building a strong network of blood donors, ensuring that every patient in need has access to this vital resource.

For more information about becoming a blood donor or how to support NYBCe, visit 

, is senior vice president, corporate communications and public affairs for New York Blood Center Enterprises. She leads engagement with external stakeholders, internal and external communications, fundraising, government and community relations.

, serves as the head of nonprofit healthcare banking and deputy head of specialized industries within J.P. Morgan’s Commercial Banking business. Her team, which serves distinct industry verticals that necessitate specialized banking coverage, provides bespoke financial solutions and facilitates access to J.P. Morgan's comprehensive, global capabilities.

As the American population ages and donations decline, raising awareness is a crucial first step to replenish supplies.

How primary care physicians can help safeguard the nation’s blood supply

Management Service Organizations (also referred to as an MSO or MSOs), remain a popular approach to structuring health care relationships and transactions. Although easy to organize and operate, there are many legal and compliance issues of which to be aware in order to assure a long-term and successful undertaking. This article will explore how and why MSOs are used in health care and some of the specific challenges in the current health care legal environment.

What is an MSO and what is its role in health care?

An MSO is a third-party entity that provides a variety of non-clinical services to health care providers. These services can include practice management, revenue cycle management, human resources, compliance, IT support, marketing, billing, collections, compliance, payor contract negotiation, vendor contract negotiation, payroll, payment of taxes, and more. Some MSOs also provide infrastructure, such as practice space, surgical suites, and equipment.Essentially, MSOs act as business partners, enabling health care facilities to outsource administrative burdens and optimize their resources.

For physician practices, an effective MSO can play an important role in implementing quality improvement programs, enhancing patient satisfaction, and maximizing efficient administration by offering industry insight, consulting and related guidance. Additionally, byoutsourcing non-clinical functions, health care providers can arguably reduce overhead costs associated with maintaining in-house departments and allocate more time and resources to patient care, improving overall health care quality and patient outcomes.

Many practices seem to thrive when using an effective MSO, with streamlined operations and improved efficiency. From a compliance perspective, MSOs can also be an excellent way for a practice to stay current, and ensure ongoing compliance, with a variety of significant legal concerns, such as the Health Insurance and Portability Act (

 (AKS), Physician Self-Referral (Stark) Law , billing and coding compliance, contractual relationships, state licensing laws, and Medicare and Medicaid reimbursement rules. Many MSOs also help practices structure and run effective fraud and abuse compliance programs that they otherwise would not be able to support on their own. Addressing these legal challenges requires MSOs to have a comprehensive understanding of health care laws and regulations, engage legal counsel with expertise in health care law, and implement robust compliance measures to mitigate legal risks effectively. At a time when many independent providers are overwhelmed with administrative, legal, and other burdens of operating a health care business, MSOs can often be the solution for practices that feel challenged to remain independent.

What is the Role of the MSO in health care transactions?

In many states, clinical practices can only be owned by licensed health care practitioners.This is based on the corporate practice of medicine (CPOM) doctrine. Generally, the CPOM doctrine is intended to prevent unlicensed people from involving themselves in key decision-making of a clinical practice in a manner that would impact patient care. In some states this doctrine is codified, while in others it has been developed through case law or administrative decisions.

To avoid the CPOM doctrine in applicable states, MSOs do not directly own the clinical practice, and instead enter into long term management agreements with a practice. Through these agreements, the MSOs manage and provide all non-clinical needs of the practice. In return for its management services, MSOs are paid a significant management fee, with MSO profits ultimately distributed to the MSO owners. With the wide array of services and items being provided by the MSO, the management fee typically draws out all revenue of the practice, other than clinical provider compensation.

The MSO approach is also the structure used in most physician practice sales to private equity (PE) entities. In the typical model, the PE buyer acquires all of the non-clinical assets of the practice (furniture, equipment, space and equipment leases, etc.) and hires all of the non-clinical staff providing services to the practice through the MSO. The management agreement between the MSO and the “acquired” practice will then provide and control nearly all of the operational needs and services of the practice. The only function of the practice at that point is the clinical care of patients and the payment of management fees to the MSO for handling all other non-clinical aspects of the practice.

Most MSOs are careful to comply with CPOM by taking steps to assure that only physicians make decisions impacting clinical care and operations. Often this is done through the creation of physician-led advisory boards that retain the power to control clinical-related decisions, as well as having all licensed health care providers directly employed by the practice and not the MSO.However, many decisions controlled by the MSO can still impact clinical operations, such as non-clinical staffing levels, scheduling, choice of equipment and supplies and similar matters. For this reason, there are still many who argue that this approach has allowed MSOs to become a vehicle for unlicensed persons to become overly involved in the day-to-day operation of health care practices, which ultimately influences physician decision-making and impacts patient care. This very issue is the subject of a lawsuit against Envision Healthcare, which is facing a challenge from the American Academy of Emergency Medicine. The AAEM has accused Envision of violating CPOM. The accusation is based on the assertion that establishing medical protocols, setting staffing levels, establishing patient encounter quotas, and determining physician best practices and quality metrics constitutes a level of control in violation of CPOM. This case has not yet been decided but is a good example of the type of risk that may be faced by MSOs that do not take the time to carefully construct their roles in a manner that does not pose legal risk of violating the CPOM.

From a compliance perspective, parties must be cognizant of many other laws that can impact arrangements between MSOs and health care practices. This includes the federal Stark Law and AKS, as well as the state equivalent of such laws, which can impact the structure and amount of management fees that can be charged. Additionally, other state laws, including fee-splitting restrictions, can impact the management arrangement and fees between an MSO and a practice.All of these laws must be reviewed with regulatory healthcare counsel.

What are the recent challenges for MSOs involved in health care transactions?

Due to increasing concerns about the role that non-clinical parties are playing in the health care industry, many states have started to scrutinize health care transactions by requiring advance state approval. The new laws involving health care practices are intended to capture transactions that are too small to trigger federal antitrust filings under the Hart-Scott-Rodino Antitrust Improvements Act of 1976, which mandates reporting of significant transactions to the Federal Trade Commission and the U.S. Department of Justice Antitrust Division. States with these laws now have the opportunity to evaluate the potential impact of certain health care transactions within their borders, but it is too soon to determine the ultimate impact of such laws. As of Jan. 1, 2024, the following states have reporting requirements for health care transactions: Connecticut, Illinois, Massachusetts, Minnesota, New York, Oregon, Rhode Island and Washington. In any type of MSO-related health care transaction, it will be key for participants to check with counsel to determine whether these state laws apply to a transaction and, if so, how to meet the filing requirements.

As the health care landscape continues to evolve, MSOs are expected to play an increasingly integral role. Advances in technology, such as telemedicine and AI-driven analytics, likely will shape MSO offerings, thereby enhancing efficiency and patient engagement. Furthermore, MSOs may facilitate collaborative care models and support population health management initiatives, driving better health outcomes on a broader scale and reducing healthcare.

MSOs are pivotal in supporting health care providers by handling administrative complexities, enhancing operational efficiency, and ensuring compliance with regulatory standards. While challenges exist, the benefits of partnering with MSOs far outweigh the risks, making them a cornerstone of modern health care management strategies. As the industry continues to innovate, MSOs undoubtedly will remain indispensable partners in delivering high-quality, patient-centered care.

Ericka L. Adler is a shareholder and manager of the Healthcare Practice Group at Roetzel & Andress in Chicago. She focuses her practice on regulatory and transactional health care law, in compliance counseling, structuring, and implementing complex joint ventures to comply with state and federal laws and regulations. She can be reached at 

Management Service Organizations (MSOs) are third-party entities that provide non-clinical services to healthcare providers, enabling them to focus on patient care while ensuring compliance with legal and regulatory standards. MSOs help healthcare practices navigate complex legal environments, such as the corporate practice of medicine (CPOM) doctrine, by managing non-clinical operations through long-term agreements. They also play a crucial role in healthcare transactions, especially in physician practice sales to private equity entities. Despite challenges, MSOs are expected to remain integral to healthcare management, driven by technological advancements and evolving industry needs.

The legal and compliance issues of Healthcare Management Service Organizations

What practices need to know about MSOs

The shocking truth about immigrants in health care

The US health care system is facing a looming 

 in the next decade. Some professions are facing bigger shortages than others, but immigrants are playing a key role.

 found that immigrants may be playing a much larger role now than some realize. Here are the key findings:

The US healthcare system is projected to experience significant shortages of physicians and nurses over the next decade, with certain specialties more affected than others. Immigrants are increasingly crucial in addressing these workforce gaps. A study by Remitly highlights the substantial contribution of immigrants to the healthcare sector, suggesting their role is more significant than commonly perceived. This underscores the importance of immigration policies that support the integration of foreign-trained healthcare professionals to mitigate the impending workforce shortages and ensure the sustainability of healthcare services.

With massive shortages looming for both the number of physicians and nurses in the U.S. in the coming decades, immigrants are set to play a key role. 

Gary Herschman

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