As they pursue contracts incorporating pay-for-performance, bundled payments, and shared savings arrangements, provider networks are faced with deciding how to distribute revenues received under these alternative payment models. One critical consideration is compliance with the fraud and abuse laws and IRS rules by meeting fair market value and commercial reasonableness standards.
Valuation concepts upon which providers traditionally relied to evaluate provider compensation – such as comparisons to market data – have limited relevance outside fee-for-service reimbursement models. Instead, providers require new tools to design and evaluate distribution, formulae to incentivize specific provider behaviors, and to properly account for infrastructure investments and operating expenses.
PYA’s professionals have the expertise and experience necessary to assist with the full design and valuation of these arrangements. Once an appropriate distribution model has been determined, we can deliver a comprehensive opinion supported by our specialized knowledge and appreciation of the evolving healthcare reimbursement landscape.