In the second podcast in this series with hospital general counsel on the front lines of the coronavirus pandemic, Sarah Swank, Counsel, Nixon Peabody LLP, speaks with Timothy Adelman, General Counsel, Luminis Health, Robert Gerberry, Senior Vice President & General Counsel, Summa Health System, and Elizabeth Wohl, General Counsel & Chief Compliance Officer, Brattleboro Retreat, about the challenges their health systems are facing and how they are dealing with those challenges. From AHLA's In-House Counsel Practice Group.
To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.
In the second podcast in this series with hospital general counsel on the front lines of the coronavirus pandemic, Sarah Swank, Counsel, Nixon Peabody LLP, speaks with Timothy Adelman, General Counsel, Luminis Health, Robert Gerberry, Senior Vice President & General Counsel, Summa Health System, and Elizabeth Wohl, General Counsel & Chief Compliance Officer, Brattleboro Retreat, about the challenges their health systems are facing and how they are dealing with those challenges. From AHLA's In-House Counsel Practice Group.
To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.
Welcome everybody today, uh, to, uh, the GC round table, uh, about Covid 19. Today is April 10th. Um, Sarah Swank from the law firm of n Nixon Peabody, and out of the office in Washington, dc. Uh, today I have with me three general counsels, uh, Tim Edelman, uh, Rob Berry, and Elizabeth Woo. And we'll talk a little bit today about covid 19. Um, so let's just jump in. Uh, everyone I talked to said their their days have changed dramatically since, um, COVID 19 Pandemic started. Uh, Tim, what are your, what does your day look like? I mean, are you in meetings all day? I just, I just talking to, um, uh, general counsel who just said like, I have weekend meetings. What, what is, what does your, what does your day look like?
Speaker 2:Yeah, it's, it's interesting. The, the day has changed, obviously, in response to what we're dealing with, but, um, I actually missed the in-person meetings. We had quite a bit. We have a very, uh, engaged, uh, leadership team here. And, you know, one of the things when I first started here was, uh, not prepared for the number of meetings that we have now. Uh, we are obviously social distancing. I, I'm, uh, working at the health system, uh, every day, but, uh, we don't have our in-person meetings, so we're using all the different tools out there, zoom, et cetera. And I'm sure everyone's got their experience with that. Um, but it's, it's a mixed bag in terms of, uh, the day-to-day covid response, uh, uh, team in, in the sense that we, we have our experts who are handling surge modeling. We have, you know, people who are working on, uh, policies and, uh, allocation scarce resources. So I would say within a day, I'm probably dealing 60 to 70% with specific, uh, pandemic response issues. And the rest of it is, is the day-to-day operations of a health system. So, uh, definitely a change, uh, in, in that realm. And, and we certainly feel the change, um, just from a, a culture and a workforce with social isolation. We have, uh, a number of employees telecommuting and, uh, you know, there's a lot of stress associated with responding to this. And so that, that is probably the biggest change, is just the feeling of, uh, of the tidal wave coming.
Speaker 1:So, um, yeah, so it's interesting. What percentage are you spending your time of? We've had people say it's a hundred, 150000000% or 50%, or, uh, and somewhere in between. Um, Elizabeth, are you, what percentage of your time do you think you're spending on Covid 19 response? And, um, are you going on site? Are you, are you, you telecommuting?
Speaker 3:Yeah. Um, I am on site. I, uh, had a request from my leadership team about a week ago to assess whether my team should be working remotely, which made me laugh a little bit because I am a general counsel's office of one. Uh, I do have a part-time compliance officer, um, and a couple of other part-time folks. Um, so I said, well, my team can work offsite. That means my part-time compliance officer can be from her house. But I, uh, most of the general counsels in Vermont, um, are staying at their hospitals and staying close. I would echo that almost all our meetings are by Zoom. And whenever we, you know, discover ourselves in the same room together, there's this sense of, okay, let's make, let's make sure we're trying to stay six feet apart. How do we spread out meetings that really need to be in person meetings? Um, but we've also, you know, we've had, um, a board meeting and we'll likely have another board meeting relatively soon that have been by Zoom. Um, so, so there's a lot of social distancing. What percentage of my time is spent on Covid? Um, it's, I would say in an average day over the last month, 90% of the day is spent on, uh, covid related issues. So not necessarily, uh, obviously my role is not in, um, what are the infection prevention measures or what are the, um, what are the steps that the hospital's actually taking? Um, but there are a lot of financial pressures on small hospitals. I'm sure I'm not alone in saying that related to, um, changes in reimbursement, um, the, the changes in, uh, wet outpatient care can be provided or is provided, um, and then just the ramping up of, um, additional needed, additional resources. So I spend a lot of time on that. Um, and then the other thing that's interesting about being in a psychiatric hospital, and it's a psychiatric hospital with involuntary patients, is that we have patients who have to go to court. Uh, and so a huge part of my time has been spent figuring out how patients who are locked in to their units and, um, for whom we're not really allowing in-person visits, can still access justice and their lawyers and their, um, peer representatives.
Speaker 1:Oh, that's interesting, Elizabeth, because, you know, we think about how we respond and have outreach to our communities and ensure our patients are safe, but also that they, they have access to to their rights as well. That's a very, a very interesting, um, observation. Uh, Rob, uh, can you tell us a little bit about what your days are like and what are some of the things you're working on?
Speaker 4:Sure. I think, um, I would echo Tim's comments around kind of my allocation of ours and the change in the, uh, nature of being in person with people versus using some of the technologies that are available to us. Uh, we sent our workforce, uh, remote pretty early on in this, our governor here in the state of Ohio was pretty aggressive, and it's really helped our state, I think, uh, in sending people to a remote workforce. We actually had someone on my team, uh, that is presumptive for the onus early on. So I think it was, um, good that we had people already on a work from home model as we look to manage some of the issues there. I think my days have changed in that I'm spending a lot more time on government relations. That's a, uh, function that reports up to me. So helping our teams, uh, on the clinical and operational side, understanding all the new regulations, all the things that are coming out at them in real time. I'm spending a lot of time with our incident command team and trying to answer questions as they look to formulate our strategy to address the potential surge that may be coming. I'm finding that, you know, whereas in my day, I used to spend more time on business and strategic issues. I'm getting a lot deeper insight into what a lot of our clinical departments do is we're helping them operate new models or change the paradigm they've always operated under before is they're shifting the way they focus some of their, um, core operations. And I'd say that the biggest issue I think we're facing now is work has really become a seven day, 24 hour, um, effort. And that you want to do all you can to support your clinical teams for are those frontline providers during these times, and they're asking for information in real time. They're asking you to take very complex things that are being thrown at us and try to synthesize or distill that down into a manageable form. And I think that's the key thing we've been focused on right now, um, in our function. Yeah,
Speaker 1:I was gonna say, it used to be you get, um, you know, the email at like 10 30 and you'd say, oh, you're not supposed to be working now. But I was like, what are the hours now? It's like people are emailing and work's happening, and, and healthcare always was 24 7, but I, it's interesting to see how many people are online or working at, at various hours. Um, one of the other things that I think it has been interesting, having a perspective of helping those across multiple states is, uh, and those in surge areas versus those that are prepping for, um, surge shortly, and then those that are not certain rural versus urban. Um, we have a good mix of that on the phone right now. So I'd really like to hear your perspective about what's happening in your states and your communities and how you're reaching out to your communities. Um, so we've got Vermont, Ohio, and, and Maryland, uh, um, on the phone right now. Um, so why don't we start with Maryland. Um, Tim, why don't you tell me a little bit about your community outreach and sort of what, what you're seeing happening in the state?
Speaker 2:Uh, yeah. So we, you know, we, like Ohio, have a very, uh, aggressive governor, uh, and we're thankful for that. Uh, we, we implemented a number of executive orders early on, including expanding, uh, the type of providers that can provide care in the state. Uh, we, uh, uh, stopped elective, uh, procedures, uh, on March 16th. And so trying to stay ahead of the curve, uh, we have a, uh, an active, uh, hospital association who's been hosting, uh, biweekly calls with all the hospitals. And we've been collaborating with our colleagues across the state on a variety of resources, uh, for example, surge modeling. So internally, we've developed our own surge modeling, which was helping us guide us as we prepare to respond. And what that really means for us is, is the two biggest, uh, hurdles we have facing us are our workforce and our supplies and equipment. Um, and so with regards to workforce, uh, we've been really focused on, uh, maintaining a safe environment for our employees, but also ensuring that we have the capacity to meet our anticipated surge, which is looking like, uh, you know, in the, in the coming weeks to May. I think if you look at it, a couple different surge models we're predicted to have it in May, um, but we're already seeing that we're designated a hotspot, um, by, uh, by the White House. And so we're starting to see that flex. Uh, there's, there's a lot of activity going on across the state and the communities to prepare for that. We're adding capacity about 200 beds capacity, and on top of that, we're working with our other colleagues in the state to develop a uniform allocation or resource policy, uh, which will address initially ventilators and, and other resources as well. So there's a lot of collaboration, um, across the entire community within our particular patient care community. We're also collaborating with, uh, you know, for example, uh, ambulatory surgery centers are giving us their anesthesia machines to repurpose them for events. And that's been great. Those community providers have really stepped up. Our contract providers, such as our anesthesia group has agreed to act in the icu, and that's been just outstanding to see the volunteerism. We have nurses and, uh, independent physicians who have said, uh, I'll be part of your redeployment pool. And so we've really appreciated that. Um, and when we have community, uh, we have people making masks and providing food to our workers. We, we were fortunate the other day, we had, uh, the local police force with about 40 cars come through our hospital lights and sirens and signs that said, thank you to our heroes. So we're having a, we're getting a lot of support, but, uh, there's no doubt that the, the, the worst is yet to come and, and the stress will be high. And so we keep leaning on, uh, on the community and on the state to give us the resources and to protect us, and we're, we're doing the best we can to protect our community, uh, by, by giving them access to care and meeting that anticipated surge.
Speaker 1:Thanks, Tim. Um, yeah, we had some people on the last GC round table that were in surge areas, and, and having talked to some people, uh, and helping on some initiatives in New York, it's been, it's, it's, uh, it's, it's quite breathtaking. The, um, out, it's like you get to see the best and the worst in our healthcare systems in some, some ways and, and to see the best in our community, which is our communities, which is really, really wonderful. Um, Elizabeth, you're in a, you've talked a little bit about trying to ensure that your patients, uh, have access to justice. You're also in a rural area, uh, with different, uh, I guess different needs and and services that you provide. Uh, what has been, what have you've seen in the state of Vermont, uh, and what do you think's different in a rural area versus some of these urban surge areas?
Speaker 3:Y you know, I think there are some things that are similar, right? Our hospital association is really active. Vermont has 14 hospitals in the whole state. All of them are nonprofits. I think three, maybe three to five of them are critical access hospitals. So capital, uh, I'm sorry, just access to resources. The number of beds is, I think, uh, high on everybody's mind. Um, the state has set up potential surge sites using the National Guard, but there's a significant question about how to staff those sites, right? We have only a certain number of healthcare workers total in the state. Um, and the governor has, you know, I think like the governors of my, my colleagues states, our governor's been pretty proactive. Uh, he's put out a call for, um, the medical Reserve core to get Ruth hired doctors and nurses sort of back into the pool and trained up to do some of the work. I think the, the interesting thing about Vermont is that the numbers are small, right? Our whole population is smaller, um, than the city of Milwaukee<laugh>. So it is always interesting to watch a, a state, um, with such a small population, try to do the work of a state that's true in, in normal times. Um, and it's especially true in times of crisis. Uh, the flip side of that is that it is, um, we have a really strong emergency management group. They're in great communication. They are talking about how to distribute the resources on a statewide basis so that they're fair and equitably distributed, um, or appropriately distributed to the places of highest need. And I think perhaps the thing that I'm most impressed about is that even though the state is small, um, each town is really stepping up in creative ways locally to take action, to do the work, um, that they know only they can do, right? And so, um, the, the challenge that we identified at the broader retreat early on is that because it's a psychiatric hospital and has a very different kind of treatment modality than an acute care hospital, um, if we had a case of a covid positive patient here, um, without really careful protocols in place, we could spread that illness really fast to the entire hospital. Um, and rather than throwing up our hands and saying, we are gonna have to transfer these people out, or What are we going to do? We collaborated with our local acute care hospital, uh, borough Memorial Hospital to stand up a, um, unit that is ready to receive covid positive psychiatric patients, um, here at our own hospital, but staffed with, um, a collaborative team of staff from our hospital and staff from the acute care hospital, um, so that we, so that we have capability here in this region to take care of, um, the folks that may need to be taken care of. Um, that's important because we have more than half the psychiatric beds in the entire state. And so we really couldn't rely on, um, we needed to be able to take care of the patients that are already in our care in a way that was collaborative and responsible.
Speaker 1:Yeah. That's great. And, um, and Rob, you are in Ohio. What is it, um, what has been the outreach in the state and your communities, and what is, what has been the state's response? Sort of, where are you in this in the process right now?
Speaker 4:So, I'd say early on, um, as we all started to ramp up to be ready to address, uh, this illness, there was a lot of informal collaboration that was occurring. You saw health systems having dialogue. Then at the state level, um, we've had a very strong, uh, state health director and Dr. Amy Acton, who brought together a regional plan to divide the state up into different, uh, regional collaboratives to kind of formalize some of that collaboration. And I think you're seeing, you know, great sharing of experiences, great sharing of intel related to, uh, the best ways to treat and manage this disease and the equipment, uh, that's needed is to mention we're coming up with the unified resource plan on how we'll use different pieces of equipment, uh, if we run into shortages. But I think overall, uh, the biggest issue we're seeing in Ohio right now is how to keep that focus when you've been on such a hard sprint for the last several weeks when you haven't yet seen that major surge and how to keep everybody, uh, still, um, at the proper level of attentiveness to this as we go ahead and, you know, manage at a census that isn't as high as we might have expected.
Speaker 1:So one of those things I've been seeing is, um, people, this sort of dichotomy between these surge areas where there's not enough workers and the places where they've had to furlough or try to redeploy, figure out what to do with staff. And, and one of the things I I, I was thinking about having done preparedness before is we look at communities and then we look at states, and oftentimes in that preparedness, we don't look across the country. Um, we, I know there are people going down to New York and volunteering or getting or, and, and moving around. And then there's other places where I've seen, where I've heard they're, they're waiting for the surge, but they've also furloughed people. At the same time, people are trying to access either advanced payments through the Care Act, or if, if a healthcare provider's small enough, they may have loans or other means they're looking at, there's like a new FCC grant for telehealth are, Rob, are you, are you all exploring like how to kind of, from a strategic, you said, you know, you're used to doing more strategic work, but are there, are you starting to look at those different, like, staffing efforts and funding efforts? Um, and how do you involve your board in those discussions?
Speaker 4:Yeah, so our board, um, met virtually this past week, uh, as we look at, you know, the impact to our projections for this year. You know, we saw half of March, um, already start to see the impact of the, uh, governor's order around canceling elective surgeries. Um, we've had a lot of our routine appointments at our physician offices canceled. So we've taken a pretty severe financial hit early on in, um, March and April. And so now we are exploring all the different avenues that are available to us, uh, between the CARES Act dollars, both the accelerated loan program and the distribution that just came out today. Um, and how we would take advantage of that. We're looking at the FCC program around telehealth to support some of the expansion we've done in that arena. Uh, we've also had some different community agencies recognize the work that we're doing right now and also offer different philanthropy and funding to help us as we bridge this, uh, new area that we're facing currently.
Speaker 1:And Tim, how about you? How have you been interacting with your board? What type of items do you talk about and how have you been engaging them?
Speaker 2:Yeah, obviously engaging our board is, is, is critical to our organization. We have a very active board. Um, so our, uh, CEO has been providing, uh, regular routine written updates to the board, uh, during the week. And we started a weekly, uh, board briefing call, which occurs on a Friday, where we give them, uh, updates on what's happening. A and the goal here is, uh, for our board to is, is very supportive of leadership. They, they need to understand that we're maintaining our focus on our mission, our vision, our values. They're, they're giving us the authority to execute in response to the pandemic. And, and by what that, I mean, within our own corporate bylaws, we have certain reserve rights for subsidiary entities and, and powers, uh, that the board has, such as if you were to apply for a certificate of need. And so, uh, we've executed, uh, resolutions to help give us the flexibility, uh, to timely respond, such that if we need to file an emergency certificate of need to add bed capacity, we can do that without a board meeting. But then we're still having our weekly board briefings, uh, that give them a chance to stay on top of what we're doing to understand how we're responding. Uh, we update them on our workforce plans, uh, obviously a very critical part of our organization as well as our finances, our, uh, search, uh, modeling and how we plan to address the response to the search. Um, and so that, that cadence of, of weekly write-ups and debriefings is, is working well. It's, it's getting us the feedback from the board, getting the support from the board, it's giving management at time to show them that we're on top of this and we're, uh, we're being very active and proactive. And I think that's been appreciated on both sides of the equation. So, uh, certainly engaging the board is in, in a crisis is very important. It helps you all grow in the same direction. Um, and striking that right balance of, of getting the board's guidance and support and giving, uh, the management team the ability to execute in real time in response to pandemic, pandemic has been finding that right, uh, sweet spot. And, and I think we're, we're hitting that stride right now, which has been great.
Speaker 1:Tim, is there any, like, advice you'd give to those that are listening to General Counsels or those that, those that have responsibility, um, from a legal perspective in supporting the board? Do you have any advice for them? Anyone who's listening that's in that role? Yeah,
Speaker 2:I, I do. Um, you know, one of the challenges is everybody, every citizen, uh, anyone who's being affected by this pandemic anywhere wants information. They want to know what's happening, how many people are infected, what is, what is the capacity, what's, you know, life expected, all these really challenging questions, and being a board member doesn't make you any more immune to wanting that information. At the same point, um, we have limited capacity to do our jobs and to respond to the board and get the board's input and to drive the organization. And so you really have to find that balance, and that's why keeping them up to date on the demographic information is really important on a regular basis. And then having these more high level briefings, um, where they can really assess, are we being responsive to the workforce? Are we, uh, being responsive to our financial needs? Are we maintaining our mission, our vision, our values are, are living healthier together motto, uh, as we support our community. And so one of the things we've done in that realm is, is put together a document based on a number of resources out there. I mean, the one thing about this pandemic is there's a lot of resources being developed for it and a lot of guidance. And so we took some of those and put together some, uh, standard areas of focus for a board and a crisis, looking at workforce, looking at mission, vision values, looking at, um, finances and quality and risk management, and giving the board some insight as to areas they can focus on. And then equally management. So, you know, it's, it's a two-way street. We, we need to know what the board wants to hear from us. And so putting something down on paper and having a, an understanding and then having a routine cadence on the flow of information will really help the organization move forward together. And so I would recommend that that organizations proactively look at, at how to engage the board and come up with a mutual understanding of what that engagement looks like, uh, and then stick to the plan. Um, and that's really important.
Speaker 1:Great. Tim, that's wonderful. I, it's really good advice to hear cuz it's, it's probably is hard to strike that balance right now, uh, with the board. Um, Elizabeth, let's talk a little bit about telehealth and, and just how patient care and operations have changed since your patient population's a little bit different than an acute, uh, care hospital. Why don't you tell us a little bit about your patient population and then are you utilizing telehealth, like you said, you, you know, that there's, um, more of a risk of, of a spread of when you have, uh, in, in patients in the, in, in that way, but just, it would be nice to hear a little about, about that. You know, we've gotten guidance from, uh, the government around, uh, you know, whether or not opiate addictive patients should even go in for treatment during this time. Um, whether it's better to try to treat them at home. And then how do you keep in contact with them? Are they then outpatients? Uh, it would be just, it'd be nice to hear a little bit about that for those who either are at psychiatric and addiction, um, facilities or who have that patient population they're trying to care for.
Speaker 3:Sure. Thank you. So I, I have to say I, the bra retreat I'm really proud of because it, um, really started to explore telehealth several years ago, um, in a variety of ways, both primarily, um, to start with, we began to use Telepsychiatry on our inpatient units. So our attending clinicians, um, see their patients over a Zoom connection basically, which until four weeks ago, nobody knew, or I didn't know much about how Zoom worked. And now everybody knows how Zoom works. Um, and Zoom works really well it turns out. And so we had a depth of experience with inpatient telehealth. Um, we had a lot of client feedback. There are patients, um, and there actually are starting to be some interesting studies about, uh, patients tolerating and even enjoying visits with their psychiatrist over, um, over video conference technologies better than inpatient in-person visits. Um, and that may be particular to psychiatry, but it's an interesting phenomenon. Um, so that piece of our experience meant that we could then scale pretty quickly into the outpatient world. Um, we have a robust outpatient clinic, um, as well as both, uh, partial hospitalization and, um, intensive outpatient programs, which are sort of two intermediate steps. Um, partial hospitalization and i o P are both group-based. And so that's been the hardest thing for us to move to remote, um, care, although we are starting to explore whether there are some group-based, uh, virtual groups that we'll be able to provide, um, and, and really get compensated for is the outstanding question. Uh, the flexibility that, um, the Office of Civil Rights has provided around HIPAA has made it, um, even a little bit easier to move our outpatient visits to, um, telepsychiatry or telehealth visits. And so a lot of our, um, almost none of our outpatients are coming into the clinic right now. Uh, but they are still in contact with their therapists and almost always there in contact with their therapists over, um, a video connection, um, so that they can, they can still see both their, um, clinicians for therapy and their physicians for medication. Uh, it is true, I would say. Um, so we have an opioid treatment program here, and that has been a place where I've been called upon to provide a lot of advice because they have, you know, patients very new in care who under normal circumstances would require, um, daily visits to the clinic, uh, in order to get, um, medication assisted treatment. And the, so they have been engaged in a very careful patient by patient assessment of who is safe to go out with more than one day's dose of medication, how much, how are we gonna stay connected to them, um, and what do we do? Interestingly, I mean, I'd say a challenge in rural, a challenge specific to rural ver Vermont is that these are patients who are traveling many miles to get here and they don't always have cars. And so the question has been, so if people are coming in for daily doses, uh, and the bus system shuts down, then what happens? And can we, can we get medication out on a delivery? And what are the risks involved in that? Um, so that's been a really interesting conversation particular to addiction treatment, um, that it, that we've been, that we've been working on here.
Speaker 1:Yeah, it seems like some of these changes may end up solving some of the issues we were kind of struggling with as a healthcare industry or system. Anyway. Um, Rob, you have a, uh, an ACO and, um, and actually a very well received aco. Um, speaking about, uh, working through populations and population health, um, how has your ACO adapted? And we know that there's some of these programs that have been put on hold or were, um, through the CMMI demonstrations and you know, I I I can't imagine that it would be easy to, you know, um, population health would be very important now, but at the same time, if we're looking at pay val, you know, payments for value, I mean, I think we're prob I would assume the ACOs are providing a lot of value, populations providing a lot of value, but maybe the, the, the outcomes are not gonna quite be the same or the same patient population. And clearly we have a, a pandemic disease that doesn't have a, a treatment, um, ne necessarily the testing we need. Um, and, and obviously, uh, you know, it's hitting those most vulnerable that normally maybe we would try to focus on in, in a population health, uh, system. So can you tell us a little bit about your ACO and what's been going on on with your aco?
Speaker 4:Sure. And kind of building on the prior comments that were made, I think through our aco, we've always hoped to be able to have tools like telehealth where we could do more remote monitoring of some of our patients and really have them accept that medium as a way to stay in contact with our providers and manage some of their chronic conditions and things that need, um, that kind of oversight. And I think we're all seeing, uh, change right now and people's mindsets around, uh, viewing telehealth as a real way to connect with your provider and making sure that they could best manage your care. So that's been a focus for us as we think about ways to connect with people in their homes right now, is how do we use that telehealth, uh, modality to kind of stratify our population, get to the riskiest patients first, make sure their conditions are managed, but also have that medium available for people who want more routine care, who want not to come into an urgent care or into an emergency room, but use telehealth to, uh, kind of triage their condition and decide, you know, where's the best, uh, place for them to receive their care.
Speaker 1:Have you in, in working, in looking at your department, Rob, have you, how have you been managing your in-house counsel staff and your outside council, um, needs and how have you been deploying those? And I guess the other part of that question is do will it be different now versus like six months from now or a year from now? How are you allocating your co your legal department resources both internally and externally?
Speaker 4:Sure. And we've got, uh, relatively small department of three attorneys on our provider's side of our business. We have one attorney on the health plan side of the business. And so we've had those internal folks work on, uh, partnering up with our internal consumers who are trying to again, analyze all the new regulations and, uh, waivers that are coming at them, uh, to best understand how to implement those. We're continuing to use outside council for subject matter expertise, um, to supplement that work. And so we've continued to partner with the outside council to do that. I think the challenge we all face right now though is with the mandates we're getting around expense control and this environment where we've seen such a revenue hit to our business, how do we continue, um, to strike those, uh, partnerships in the right way so that we don't lose those connections with our outside council and at the same time strike some kind of alternate fear or value-based arrangement that allows us both to navigate through this crisis together.
Speaker 1:And Tim, have you seen the same, um, kind of flexibility with outside council and, and how are you using your kind of internal resources versus external resources?
Speaker 2:Yeah, I think one of the things that happens in a, in a crisis like this, our pandemic like this is some of your traditional transactional work starts to get put on hold. And so, uh, deals that we would've engaged outside council with aren't moving forward as fast, although we are trying to keep our focus and keep the business operations moving forward, but they're not moving forward as fast. And so a lot of the outside council demand right now is, is pretty subject matter, uh, specific and, uh, relating to Covid and that, and that's been the, the focus. We've been managing a lot of the internal work here. I will tell you that there's a great community of sharing information right now. Not only, uh, in-house council to in-house council, uh, both within the state and across the country, but also even, you know, a lot of the firms and consultants are putting out great products out there that are helping everyone move forward. Um, the hard part, and I get it, is, is at what point are we, are we using these valuable resources that they're providing to us versus at what point do we need to engage them for a specific project? And I would say, um, you know, the vast majority of the time we're receiving content that is, that is helping us identifying funding sources or policies or waivers that have been identi uh, put out there that may not result in us needing to engage on a, on a billable project. But with that said, those or those organizations and those firms, outside firms that really come to the table with a solution, um, are the ones that we can use right away because this is moving fast and, uh, we don't have time to recreate the wheel or to learn about a subject we really need, uh, you know, quick answers. And so that's where we're starting to go to our outside resources, including, uh, the law firms and even the consulting firms to some extent. And, you know, the only only thing I could say is, is I manage that process, internal versus versus external. It really is looking for that external expert who has the solution now is the person that I need to engage versus, you know, working to develop a solution in the future. Cause time is, time is of the essence.
Speaker 1:Yeah, it was, uh, it's interesting cuz it's been, I the idea of, you know, I think I have three, well, again, I'll count myself on this. We have four creative thinkers on the phone. I think good legal, creative thinkers, and I think it's never been a time to be, um, compliant and creative. This, this would be it. Um, it's been quite interesting. I never thought in my life that I would be working on a fashion contract for math. You know, like I just, who, who knew that that would ever be something that any of us would work on. Um, so Elizabeth, uh, you're, you're a department of of one, so<laugh>, so when allocating resources to yourself and outside, you know, how are you, how are you balancing that? How are you, and we talked a little bit about what your day is like, but how, how are you figuring out where to go, what resources to use and, and when do you feel like you, you personally are just, you know, need to like, you know, raise your hand and say, I need help right now?
Speaker 3:You know, I think, um, I I really appreciate, um, all the comments so far because I think what this has challenged me to do in some ways is to really challenge my, um, internal departments to think for themselves before they come talk to me. Um, or to really to like, to not practice law, but to use all their practical, know-how to get as far along in a policy, for example, related to remote access to the courts before they say, now, now I need your help. Um, right. Because I have to really be at this point, um, extremely responsive to my, my colleagues on our executive leadership team and the board, um, who as other other folks on the call have said are, are both in need of, um, answers and answers fast. So actually it's been a really good exercise for me where I might have, um, earlier just taking the work because writing is easy for me and sort of an analytical thought process is easy for me. I might have just done it now. I get to push it out, really challenge people, um, to take a first stab at a draft of a pro a procedure or protocol first, um, and then bring me a draft. Uh, so that is one way, um, is just to push the work to people who I know can't do it, but might not otherwise choose to do it. Um, and then I'm really fortunate, I would say that broader retreat has, um, a number of outside firms that we work with and they have been, um, really willing to either considerable consider flexible fee arrangements to be responsive whenever we need them. I mean, I think the, in the law firm world, I feel like operates on a 24 7 basis anyway, even when they probably don't need to. And so they understand right now that their clients need them to, and, and all of my outside contacts have been incredibly responsive to our needs and willing to either write off time or, um, be flexible in their billing arrangements. So it's really mostly a matter of identifying where I need help and asking for it. Um, and that's the hardest thing in, in the, you know, the space of a day is taking the brain space to, you know, get out of the, get out the muck, come up to 10,000 feet and prioritize the work in a way that then allows me to get it done.
Speaker 1:So, you know, Elizabeth, that's really good advice for in-house counsel, especially the, there's maybe some lessons learned even into the future. Right. Um, Rob, do you have have any, uh, advice for in-house counsel right now, either, you know, in preparing or responded to Covid 19?
Speaker 4:Sure. I think the hard part is, um, we have so much information coming at us fast and furious, and it's a lot of great content, as Tim said. I think being able to create some kind of tracking mechanism or dashboard that you can share with your board and your executive team to help, um, again, synthesize or distill that down so that it can become actionable for them. I think otherwise, I've seen a lot of people who are running at a very fast paced and trying to create operational change, really struggling with all the things that are occurring right now in our industry. And I think one of our challenges in our role as in house council is how do we, um, bring forward information to our leadership in a way that it's done, um, quickly and in a way that they can quickly act on it.
Speaker 1:You know, it's interesting, I was talking to someone in-house in a surge area this week, and you know, we always talk about in healthcare, especially if you do population health or ACOs or any, you know, digital health, you hear about like, you know, building the plane as you're flying it. And she described it as, um, uh, instead of building the plane as you're flying it, watching it nose dive while you're building it and trying to fly it. So, um, which is quite, quite interesting. So, um, Tim, do you have any advi do you have any advice or lessons learned for in-house counsel that you could share with us?
Speaker 2:I, I think the, you know, and I'm sure many of them are already already aware of this and may be even helpful for some of the outside counsel as well. It's really focusing on what's happening in, in, in the hospitals, in the care clinical care areas. Um, there's a lot, there's a lot happening. Uh, you know, people are being redeployed and doing new clinical services they haven't had to do in a while to meet surge capacity. We have people talking about allocation of scarce resources. Uh, we have people who are worried about the fact that they're gonna be in the hospital treating a patient, then have to go home to their families and really having that sensitivity to, to the frontline. And we do see a lot of praise for the heroes, like the healthcare workers out there. And that's, that's critical. And I, and I, I can't be understated. There's no way we could say thank you enough to them. And so, you know, as in-house council, we're here to help them and we've got waivers, we've got ways to do our job to actually deliver the care we need to, and, and being creative at this point is, is really important. And being, uh, enabling is really important. We will adhere to, you know, the standard operating procedures when it comes to regulations and compliance, um, and we will use the waivers where we can to meet the goals. But at the end of the day, um, there absolutely needs to be a focus on giving the healthcare workers, the clinical team and their support teams, the resources they need to do the job. They've got so much stress and so much anxiety on them. And, and, you know, as someone once described it, it's like the tidal wave. The waters have receded and you know, the volumes have gone down and then all of a sudden you're gonna have the big wave come and preparing. Now being prepared for that, supporting your workforce, supporting your clinical machine, uh, now is, is critical. And even though you see these low volumes, um, know that it's going to ramp up and when it does, having that infrastructure in place and having that support is gonna be the difference between, you know, coming out on top with your community and versus being overwhelmed. And so, I, I just can't stress enough the need to support that workforce and that clinical enterprise to do the job because it's just an overwhelming job to be asking them.
Speaker 1:Yeah, it's, I, it's hard. I think probably a lot of us f a lot of us feel this way. It's how, how did we get in a situation where we didn't have what we needed? But, you know, we could probably have a whole five series podcast on how, how we got here, but here we are. And, you know, I'm trying to think, and let's like kind of end this by trying to ha talk a little bit about what the si next six months are. A lot of people are trying to guess what that might look like. Um, you know, there's some studies done, uh, on antibody testing. We're looking at hopefully having some rapid testing. Um, people are, we saw some of the federal funding around screenings change, but, you know, with this idea of like, you know, hope or, or maybe where we may be. Um, Tim, why don't you just end my, we'll end by each of you just telling a little bit about where, where you think we might, might be in six months and, and hopefully end in a little bit of, of hopefulness. Um, Tim, why don't you start and then, um, Rob and then Elizabeth.
Speaker 2:Sure. Um, you know, th thanks for having us on this, on this podcast. It's great to have these dialogues. The, uh, you know, as we look at our surge modeling and we see it ramping up in the coming weeks with a peak likely in May, and then the, and then the downturn happening through the beginning of the summer, um, we are, uh, establishing our, our forecast in a way that gives our ability to redeploy our workforce, uh, to maximize our employees and to maximize our clinical enterprise. I, I would think, and I'm hoping that, um, by late summer, uh, unfortunately that long that we will start to get back on track. With that said, we already are operating in a new norm, so we have, as everyone else is experiencing a significant overwhelming increase in telehealth visits. And we have, uh, a lot of people who are chipping in, in all different areas to, to make this happen. So, uh, it's gonna be hard to maintain social distancing, it's gonna be hard to maintain certain clinical enterprises that are shut down, elective procedures, et cetera. Um, but the reality is if we do it and we do it right, and we have lessons learned from history, if we do it right, then hopefully by the fall we start to see things come back online. And so I'm, I'm looking forward to this becoming a new greatest generation for us.
Speaker 1:<laugh>. Great. Tim, uh, Rob, how about you? Why don't you tell us a little bit about where you see the next six months and, and, and maybe into the future again with this idea of maybe hopefulness?
Speaker 4:Sure. So I think, you know, one of the things is without a vaccine that's out there, I think we're all gonna be forced to do what probably attracted a lot of us to healthcare, uh, in the first place, is to continue to try to re-engineer a system to make it most effective and efficient. Um, when we look at, um, social distancing and we look at creating, um, the right method to get our patients and to be seen, how do we change the way, you know, people come to doctor's offices, are they no longer gonna sit in waiting rooms? Are we gonna create ways using technology like our phones or different apps to get people in where they can't have the proper spacing that allows them to be best protected, uh, from other parts of the community? So I see the next six months, uh, being a continued challenge, but I think it's also continued opportunity to try to make this system better, not only for the short term, but for the long term as we come out of the covid crisis.
Speaker 1:How about you, Elizabeth? What are your thoughts on this?
Speaker 3:Uh, wow. It's hard to go last when everybody is so smart,<laugh>, but I mean, in addition to echoing what my illustrious colleagues have said, uh, I think, um, I think we've already learned and the next six months are gonna teach us that, um, the people who are most important in our society are the people who do the cleaning, the people who are on our facilities team, the people who keep the air circulating the way it's supposed to circulate, right? I mean, I think it's important when we're recognizing our frontline staff to remember that our frontline staff aren't just doctors and nurses and um, healthcare techs, um, that we have a whole group of folks who are on our units providing essential services, um, that often are the last people that we think to thank, um, and we owe all of our infection prevention efforts to, um, to them in some ways. Uh, I think if our society learns that, that's an amazing thing for us to learn. Um, and I think just p uh, piggybacking, um, I think re-engineering a system to make it more efficient is really important. Um, and not losing the, um, social engagement challenges that we, um, right, that we are human beings, we need to see people, and so how do we create a system that's efficient and, um, minimizes, reduces, minimizes the risk of infection, sorry. Um, while also remembering that healthcare is about human touch and human interaction and helping people emotionally feel better, right? That, and, and a lot of that is because of the interaction, not just because we're applying a therapy or prescribing a medication. Um, so that's a, that's a tall order even in, even in the worst of, even in the best of times, but maybe it is the worst of times that will teach us how to do that better.
Speaker 1:I think I, Elizabeth I think you did quite well. So I think I picked three very smart people to be on this, this podcast with me. Um, uh, I really appreciate Tim Elizabeth, Rob, you, you joining us today. Um, I also just want to do a big shout out to American Health Law Association for doing these and getting the information out. Um, to me this is like where I've met some of my closest friends and, um, and colleagues and I'm just really appreciative of them, uh, continuing to do these podcasts and, and being able to pull these amazing people together to talk about what's happening and to get these resources out. So if you need, uh, if you want more information, please go to the a l a, uh, coronavirus hub. We've, uh, up to date information we're, you know, the, their changes are coming fast and furious. So please, uh, please check that out and I'm sure you'll be hearing from us again. Thank you so much, everybody. Have a great day.