Our client was a physician-owned health system providing general acute care services, graduate medical education, and individually-tailored wellness and preventative health programs in 70 sub-specialties to over 1.3 million residents. It represents one of approximately 250 physician-owned hospitals across the United States. The hospital hired Applied Policy to provide ongoing expertise, support, and regulatory monitoring. The client was looking for a partner to act in an advisory role, informing them of ways the political environment may change and affect their bottom line.

In 2013, this client sought opportunities for growth but were obstructed by Centers for Medicare & Medicaid (CMS) regulations. Specifically, Section 6001 of the Affordable Care Act (ACA) prohibited the development of new physician-owned hospitals and prevented existing hospitals from expanding further. Applied Policy was hired to navigate the relevant policies and create an opportunity for the hospital to flourish despite the mounting regulatory hurdles.

The Applied Policy team employed their knowledge of the ACA and the Medicaid program and guided the client through the two potential pathways of CMS petition and acceptance, High Medicaid Exemption and Applicable Hospital Exemption. Applied Policy used their understanding of eligibility requirements to determine which avenue was appropriate for the client, successfully leading them through the application process and fixing flaws from the federal government’s side along the way. As a result of Applied Policy’s work, the hospital was one of only five physician-owned hospitals in the country who were approved for expansion in 2014-2016.