Representing Urologists in Legal Matters Throughout the Country
Frier Levitt represents urologists and urology practices in numerous legal matters throughout the United States, including at the state and federal level as well as in transactional and litigation matters. Our attorneys are uniquely suited to working with urology practices because of our regulatory and transactional experience, as well as our work nationally with physician dispensers and physician-owned pharmacies. Frier Levitt has experience, including in the areas of licensing issues, network access issues (including challenging PBMs’ improper denial of network access and network termination issues), and issues related to reimbursement.
The Impact of Value-Based Care
As our nation’s healthcare system continues its shift from volume-based to value-based compensation models, urologists are increasingly accountable for producing quality outcomes at a lower cost. In order to achieve specific quality and cost objectives, many providers are seeking legally permissible integration options, such as Supergroups and Clinically Integrated Networks (commonly referred to as “CINs”). CINs enable independent providers representing a variety of specialties, including urology to collaborate in developing policies and protocols for the delivery of efficient, evidence-based, coordinated care, and to negotiate creative, value-based contracts with payers.
Regulatory and Transactional Concerns
Frier Levitt is also very familiar with the regulatory and transactional concerns involved in physician-owned radiation therapy centers, ambulatory surgery centers and lithotripsy centers. These ancillary ventures require an analysis of both federal and state laws. Frier Levitt has experience assisting in the development of these ancillary services through both start-up and acquisition models. The firm also has experience in the development of profit distribution models in compliance with federal (Stark) and state self-referral laws.
Another prominent area of legal complexity for urologists is physician dispensing (whether it be through in-office dispensing or physician-owned pharmacies). Frier Levitt has developed extensive knowledge and understanding of these unique issues, but more importantly, has consistently achieved successful results for dispensing physician practices and physician-owned pharmacies in addressing these issues and challenges, whether they arise from the process of establishing an in-office dispensary or licensed pharmacy, or from disputes with third parties, including pharmacy benefit managers (PBMs).
Physician dispensing also presents challenges in dealing with third-party payers including insurance companies, PBMs, and the Centers for Medicare & Medicaid Services (CMS). More recently, PBMs have presented significant challenges for dispensing physician practices. PBMs have become extremely consolidated, resulting in only a few PBMs throughout the country managing the majority of prescriptions. These PBMs have almost complete control over reimbursement within their provider networks, effectively functioning as monopolies on a state or regional basis. As a result, dispensing physician practices are forced to contract with these PBMs on whatever terms the PBMs offer, often resulting in unsustainable reimbursement. Moreover, PBMs have also created many obstacles to gaining access to PBM created pharmacy networks. In some instances, PBMs do not grant in-office dispensing practices access to their pharmacy networks based on arbitrary distinctions in how the practices operate. In other instances, PBMs attempt to improperly terminate dispensing physician practices from their networks. Improper denial of access to PBMs’ pharmacy networks, as well as improper terminations, directly interfere with patient care and patient outcomes, and should not be tolerated. In addition to Frier Levitt’s comprehensive understanding of the legal framework governing these practices, Frier Levitt has an in-depth knowledge of the laws governing PBMs vis-à-vis dispensing physician practices, as well as the various PBM contracts between PBMs and the providers participating in PBMs’ pharmacy networks.
How Frier Levitt Provides Solutions to Urologists
Frier Levitt provides tailored solutions to our clients backed by 20 years of experience in the healthcare and life sciences industries. For more information, contact Frier Levitt today to speak with an attorney.