The ACO Journey, Legal Environment, & Peer Review Risks

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Overview / Abstract:

The formation of the Accountable Care Organization (ACO) fosters the concepts of providing quality, safe, financially secure care; as such fulfilling the ethical responsibility the AMA requires for practitioners.

Discuss the MSSP proposed rule on assignments, data sharing, financial benchmarks for ACO’s. Reduce your risks during an ACO Peer Review by preparing an internal audit. Improve your performance by following the dimensions of quality, accountable care goals and the four domains of care being considered. Explore Memorial Hermann’s journey to accountable care by building a high performance physician network.

At the conclusion of the activity, attendees will be able to:
Recognize challenges providers are facing as ACO roles are determined
Leverage the legal risks of shared savings programs and accountable care
Discuss provider responsibility and risk in the peer review process
Review the impact of economic profiling and credentialing in the evolution of the ACO
Discuss ACO success with population health and risk stratification tools
Review physician leadership and essential aspects of Medicare shared savings success
These sessions were recorded live at our 2016 Annual Health Care Quality & Patient Safety Conference and are a portion of the online course entitled: Quality Under the Affordable Care Act: Keys to Success.


Mar 15, 2018


Office Management , Clinical Laboratory CE, EMS / EMT / Paramedic CE, Informatics / Coding / Billing CE, Nurse Practitioner , Nursing CNE, Occupational Therapy CE, Physician CME, Physician Assistant CME, Attorney





Credits / Hours



ACCME, AOA, Florida Board of Nursing

Presenters / Authors / Faculty

Christopher J. Laney, JD, CHCQM
Chris Laney is Associate Attorney at Rogers and Associates, Attorneys and Counselors in Detroit, Michigan. Chris’ practice focuses primarily on representing health care providers in Medicare audits, business transactions, and reimbursement issues; he has significant experience representing providers in third party payer audits, professional licensing, federal agency investigations, and credentialing matters. A frequent author and presenter on compliance issues, Stark, and other fraud-and-abuse issues, Chris has been named Rising Star top young lawyer in Michigan multiple times. Chris has been an asset to ABQAURP as a frequent speaker and serving on our CME, Exam, and Item-Writing committees.

Richard Kaine, MD, CHCQM
Dr. Richard Kaine is the Director of Consulting Services for Quality Management Resources, a nationwide consulting firm and the Medical Director for Health Practice Management. Dr. Kaine has been certified by the American Board of Pediatrics, the American Board of Family Practice, the American Board of Internal Medicine, and is a long-standing, valuable member of ABQAURP’s board of directors. He is a former HMO Medical Director and Executive Director; building provider networks and credentialing thousands of physicians for national insurers. He lectures nationally about quality, utilization, credentialing, and compliance issues.

D. Keith Fernandez, MD
Dr. Keith Fernandez is President and Physician-in-Chief of MHMD, the Memorial Hermann Physician Network, the largest clinically integrated physician organization in Texas. Dr. Fernandez is the Memorial Hermann Health System Physician Champion for computerized physician order entry and has led prominent efforts in electronic ordering and evidence-based order sets for the Memorial Hermann System.

Sponsors / Supporters / Grant Providers


Keywords / Search Terms

American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) American Board of Quality Assurance and Utilization Review Physicians,ABQAURP,American Board of Quality Assurance and Utilization Review Physicians (ABQAURP),Accountable Care,Data Security,Physician Advisor,Utilization,Quality,ICD-10,Physician leadership,population health,medical home,quality indicators,reimbursement,Baldrige,quality improvement,Live,CE,CME,Seminar,ACO,Peer Review,Legal

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