AHLA's Speaking of Health Law

COVID-19 GC Roundtable - Part 4

May 14, 2020 AHLA Podcasts
AHLA's Speaking of Health Law
COVID-19 GC Roundtable - Part 4
Show Notes Transcript

In the fourth podcast in this series with general counsel on the front lines of the coronavirus pandemic, Sarah Swank, Counsel, Nixon Peabody LLP, speaks with Mark Bonanno, General Counsel, Oregon Medical Association, and Eric Fish, Chief Legal Officer, Federation of State Medical Boards. The podcast discusses how the COVID-19 pandemic has affected their associations and advocacy activities, including their biggest membership concerns, how their associations have reacted to changes in regulation, and lessons learned. 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.

Speaker 1:

Welcome everyone today to, uh, GC Roundtable, COVID 19 part four. Uh, this is Sarah Swank with the law firm of Nixon Peabody out of the Washington DC office. It's May 13th, 20. And I have two excellent people here today, uh, to talk to you. I have, um, mark and Eric. Um, mark, why don't you introduce yourself to the audience?

Speaker 2:

Sure. Thank you, Sarah. Um, and thanks for inviting me here today. Um, my name is Mark Bono. Um, my official title, uh, is General Counsel and Vice President, uh, for health policy at the Oregon Medical Association out in Portland, Oregon. And of course, uh, my unofficial title. I have multiple hats underneath that as most, uh, in-house counsel shops of just one lawyer have.

Speaker 1:

Excellent. Thank you. And Eric, why don't you, uh, introduce yourself to the

Speaker 3:

Audience? Sure. Thank you. And I'm Eric Fish. I'm the Chief Legal Officer at the Federation of State Medical Boards, and I'm in our Washington DC office. We have two locations, uh, one in Ulu, Texas, and then a advocacy office in Washington, dc. And, uh, like Mark, I am a, uh, in-house team of one, so I am both my boss and my employee. Uh, and I think we'll have a lot of shared stories here about, uh, the, the joys of that during a crisis.

Speaker 1:

Excellent. So, um, why don't we start off, um, how, with Mark, why don't you tell us a little bit about how you're kind of spending some of your time and what does a typical day look like right now?

Speaker 2:

Uh, right now? Well, it's, it's wholly unlike, um, you know, it has been, I've, I've been in-house, uh, just over five years coming from private practice before that. Um, but during this, uh, time of covid, um, as we've been calling it, uh, it's really kind of been a all HandsOn deck approach to this, uh, to help out, uh, you know, our members we're a membership organization of just about 8,000 physicians of physician assistance. Uh, and so we've pretty much been repurposed. Um, it's kind of a covid task force to help out. Uh, and, and early on, I would say back in late February, uh, early March, uh, really working on the advocacy pieces that, um, trade associations do for their membership. Uh, and then my role, uh, in terms of shifting is really kind of been broken out into three big buckets. You know, one is the advocacy piece, you know, advocating on all those issues that, uh, have been emerging out of this, particularly on, you know, securing personal protective equipment, ppe, trying to figure out the testing piece, obviously the financial pieces in supporting, uh, clinics, uh, and then now working on, you know, potential liability protections for them. Uh, the second bucket bucket I've been working on is governance issues. And there's been some unique issues there that have emerged, um, on the governance side. And then of course now the operations piece, uh, really sort of figuring out how to adapt to executive orders, you know, a shift to a telework environment, uh, you know, a human resources issue, contracting issues, kind of the<inaudible> of that stuff. And the unique thing about, um, our trade association, because we're a 5 0 1[inaudible][inaudible] advocacy organization, uh, we were not eligible for the CARES Act, um, uh, payroll Protection Program funding. Uh, it was limited to 5 0 1[inaudible][inaudible]. So we're kind of working through, uh, what that means for the organization as well.

Speaker 1:

Thanks. Um, Eric, do you share some of the similar, uh, sentiments of Mark? I mean, what does your day look like? Um, how much time are you spending on Covid matters, uh, and what does your typical day look like now?

Speaker 3:

Well, I think, uh, for all of us, or for many of us, our typical day usually starts the night before where we try to figure out with spouses and children and others, uh, who's doing what at what time. Um, so I'll wake up, uh, fairly early and, and catch up on what I would say is the routine corporate matters that I have to address, be it a HR issue, um, or something related to our buildings, uh, general corporate type of matters. Because once the world wakes up, especially in a, in a pandemic, I don't know. And none of us at the state board level know what is gonna come. Um, we've really had three phases to this point of, of our planning and, and how we've gone about our, our business, uh, supporting our state medical boards and, and supporting them with both advocacy, but also guidance in interacting with, uh, various state and federal officials. Uh, like Mark, we started planning for this, uh, crisis fairly early in, in February. Uh, f SNB is fortunate that our c e o, uh, Dr. Hank Caudry was the former health commissioner of Suffolk County during the H one N one, uh, issues back in, what, 2009 or so. Uh, and so he had been through this as a physician leader and a leader of, of a health system. And so when we started talking, uh, about what these initial cases in the Pacific Northwest would mean for our operations, for our members, where state boards would go, um, we had a early jump and good guidance on just the thinking, uh, of emergency responses. So we put together a plan, um, uh, to go remote. We had to think through some of the data privacy issues, uh, of our data systems, uh, taking 200 employees and going into a full remote work setting, um, of what that means for compliance with state laws, all these other nuances that came up, uh, we addressed. Then, uh, and then about mid, mid-March, we've shifted into a response phase. We were providing support, uh, for all of our state boards, uh, either license verification, helping them understand the federal guidance, how it applies to, uh, medical regulation, uh, deciphering the different messages that were coming from, uh, state and federal officials on what they couldn't or couldn't do, or what they needed to do. Uh, and I think right now we're in a stage where we are reimagining what regulation is going to look like in the future. Um, we're working on a H H S grant that was issued to the F SM B to improve license portability and credentialing. Um, I think that was one of the issues that they saw, uh, impeded physician mobility, but also the ability to respond as a nation. And, um, you know, we're, we're trying to do this in the midst of a crisis or remaining flexible. Um, but the answer, the, the, the question of how much time is spent on covid related matters, I would say right now a majority of the working day or daylight hours are, are covid related.

Speaker 1:

<laugh>, and the evening hours are still covid related, but then you sleep, right. So

Speaker 3:

Hopefully, and also mixed in with, uh, preschool and, uh, everything else<laugh>.

Speaker 1:

Yeah, I, that's interesting. Cause it's like, what is it when you said, um, you know, trying to do the, like, sit down with your spouse and try to figure out, um, like our morning routine now is like, okay, who has called when? And some I'm more call heavy and then like, maybe I can do a load of laundry and throw it in without background noise if I can get it done early enough. And then there's like preschool and, um, uh, it's, how are you, Eric? How are you balancing all that and what are what, do you have any tips or any war stories?

Speaker 3:

I, I think it, it's one of those things, and may be being a general counsel, you're used to, um, a day spinning out of control. As soon as you wake up, you're not sure what the email that came in the middle of the night was, and then you have to respond to it. So in a way, I think any, any general counsel's been through this on a day-to-day basis, and you just have to expand those lessons of sometimes taking a step back and seeing the big picture. Um, I will say that, uh, my four-year-old son and my, my two-year-old daughter have made several appearances as junior counsels, uh, on calls. And I think that also it adds some levity to the situation. And, uh, I think in some of the tense conversations we've had, you know, they see, they show up in the background and, um, you get somebody to smile and you just realize what we're trying to do is, is, uh, is very important, but nothing's gonna be as important as, uh, making sure those those kids are taken care of or your family members. Um, and as a company, we've even adopted that. We've, um, you know, we have a lot of people who are both scared, uh, with our two offices in DC obviously getting hit hard, um, and just being compassionate to each other first, uh, and keeping that, that focus has been part of our success and our response to this point.

Speaker 1:

Yeah, it's, uh, I, I've, um, was taping, uh, um, something actually for Homeland Securities fema, which I didn't think in my career I'd be doing. Um, but trying to get out to public officials, some of the perspective from healthcare and, and, um, at the very end, I mean, there was maybe two minutes left and I was muted, but I was still on video. My son walks in and he is like, desperately needed scissors, and I was like, where's my husband? And I can't move cause I'm on the video. And you're like, okay, what do I do? Uh, I don't wanna ignore you cause I, I know you really need your scissors right now, but I'm also on video, um,<laugh>, you know, just, I, I think it is nice to have a, some pers perspective and, you know, we are, we, we are doing things that are, um, not usual. Um, mark, how are you, how are you balancing work and the rest of your life?

Speaker 2:

Yeah, I mean, I agree with, with Eric, uh, the nature of in-house, uh, general counsel, um, you know, it's kind of what's you, you don't know what's gonna be coming next. Um, and at the early start of all this, um, things were changing almost literally by the hour, um, at least on the, the policy, the public policy side of things. And so it was just kind of hard to keep up, up on things. And it was, you know, it was a, a constant stream, um, from morning through late afternoon. And, and you kind of have to get into a, you'd kind of have to get into a balancing routine. And, and it's not just for me, it's, it's for my wife who also works, uh, down the hall to the right. Uh, and, um, my 16 year old daughter who's in high school, who has her school room upstairs, and then my 14 year old son who has his own, uh, school house in his room. So everyone kind of has their spot during the day. Um, and sometimes we shift that up, uh, depending upon who has a call that they need to be on. Um, but toward the end of the day, we try to take a break. Uh, we try to do some exercise routines together. We try to have dinner together. Um, different groups of the family have their Netflix shows that they, they work on together. Um, but it is, it has kind of settled into a little bit of routine. We kind of joke about writing a play called the Dishwasher, uh, that we empty and fill every day. It's kind of like the new version of Groundhog Day, the movie. Um, so, so there's a little bit of balancing that's going on. Um, there are, there are days that aren't so good. Um, you know, you look at the, where's the end of this? Uh, and you know, it, you being so close and working on the advocacy side, you get a lot of information that flows across your desk. Uh, and then some of it can be a little bit overwhelming and daunting, especially when you're trying to, you know, put on a positive, uh, spin for your family. Uh, you know, we're in this for a long haul, uh, and, you know, we've gotta kind of ground it in science and, and logistics and kind of figure this thing out. Uh, so again, it's just about balance. Um, I think it's possible. Uh, it's hard, uh, for sure. Um, but, you know, as a family of four, I think I, my my hat's off to, to my family, they're doing pretty well, I think. So

Speaker 1:

That's, I mean, it's, it's, I appreciate you guys sharing your insights on that, because that is part of our, our work, and we always had to balance work and, and our family life, but it is in a, in a different way that we had not anticipated. And it, like, Eric, like you said, it wasn't like it happened suddenly, all of a sudden we were all home and, and kids were not at school. Um, and they were with us all day. So I, I do appreciate you guys sharing that. One of the things you also were talking about is this Marcus, this rapid fire legal change. Um, and, and how fast it<laugh> it came and it was, I don't know how you felt this way, but it was like maybe last week or so, even though things were still quite busy, uh, it felt a little more, I guess manageable is the word. Um, I don't wanna say normal cause it wasn't normal, but more manageable, uh, because they were not changes that were happening by the hour. Um, as much did you feel that way and how did you, how did you keep up with the changes and, and were there changes that surprised you?

Speaker 2:

Um, I, uh, where do I start? Uh, nothing much surprises me today compared to four or 5, 6, 7 weeks ago. Um, I, I think the, the, the thing that's interesting here is, is how much change happens so quickly, um, and the, the rapid pace, uh, of things being rolled out both at the federal and the state level, uh, and then trying to co sort of keep tabs on all that and trying to put it in the right bucket. Uh, so you could know, come back to it at some point in time. I think the thing that, um, while I think a lot of the changes were helpful and useful, uh, particularly around telehealth, uh, and things like that, um, the concern that at least I have and, and, and some of my colleagues, uh, is what's gonna happen in a year or two when we have to start sort of unring the bell on a lot of these rapid changes, uh, that were all intended for good to help out during this crisis. Um, but how do you figure out what, what things go back to, um, is there gonna be a return to normal quote unquote? Um, I think we're gonna have to see some, you know, changes in law, if you will, whether it's statutory or regulatory, both federally and at the state level. And we know how difficult that can be, uh, you know, in terms of the, the politics around that. Um, but a lot of these changes were done sort of under the, the, the power of the executive. Uh, and now we've gotta go back and try and figure out, you know, what pieces need needed, a rule amendment or something like that, um, as we move forward. So it's, it's, it's not gonna get any easier. In fact, it's gonna get a little more complicated, um, but that's why we're all here.

Speaker 1:

Yeah. And, and, um, it's, they, it, it, it was interesting to watch all the laws that, you know,<laugh> feel like they've, they've changed and then trying to, it'd be interesting to see what will happen in the future if they'll, if it, if it will stick. Uh, I keep trying to advise people, and I, I'm wondering if you all do this too, which is, you know, this all happened and it happened quickly, um, but a year from now, if there's an enforcement action or something happens, or you have to unwind it, I, I don't, I hope we get the benefit of the doubt, but we need to make sure that we've documented and at least our intentions and, and what hap what was happening at the time, which is hard to do when people were focused on, um, the changes and also caring for patients and, and responding. Uh, Eric, did you feel a similar, uh, similarly to, to mark about the, the changes? Uh, were there any that surprised you? I mean, some of the changes that happened were things that you were, you know, working on anyway. Uh, how, how did you feel about them?

Speaker 3:

Uh, maybe some of the changes weren't as, uh, surprising, but the way they were communicated<laugh> by various individuals was the surprise. Uh, and, and left us all trying to read between the lines of, of what the new regulations meant or what a state's shift of, uh, what was appropriate telemedicine in that state during a crisis would mean for other states. Um, and, you know, we, we looked at this as an opportunity, I think as, um, as Mark said, to be supportive and be responsive, but also then think, rethink what is going to stick after this. I think, um, with say, telemedicine standards, uh, and the growing acceptance of telemedicine, I think from both a practitioner's point of view and a patient's point of view, uh, we will see some push on issues such as continuity of care, uh, or what sort of standards are appropriate in emergency settings. Uh, is it just video? Is it audio, video, video? A lot of these things need to be, uh, maybe reexamined in, in coming years to see what works. But I think, think we see, we saw issues where, uh, the role of, of state, state boards, state agencies, uh, where the emphasis was put back on the states to be the respond, to be in charge of the response. Uh, the roles of the state medical boards may be, um, become stronger in the future because they are going to take a, a bigger role on some of the management of, of the data about physicians who come into the state and how they can practice. Uh, so I think there's an opportunity here for, uh, a better form of governance that takes the good and the foundation that we had, and then, uh, rethink how some of the modern issues have impacted that. Uh, one of the things that I think, as you lose to say that I've been working on, uh, prior to the crisis has just been the use of technology, artificial intelligence, digital technologies and platforms in the administration of regulatory law. And, uh, one of the issues that we saw was just the amount of data siloing that we still have. And that's gonna be something that I think we are gonna focus on, uh, to have the data flowing about physicians who, the, who's located, where, where they're going, uh, what it takes to get licensed under certain regimes, uh, is gonna be very important. Uh, there are some, some forms I saw still required you to get a notary or to fax them or to get it signed and through the mail. And I think in a crisis where you can't go to a notary or can't go to the post office, we have to re-examine, is that really necessary? Is there a digital way we could, um, val validate documents, verify documents within healthcare, and then transmit'em, uh, and move away from, you know, like, uh, in the UK with, with the fax machines? And that's their big thing. I, I want to re-examine what that means for, uh, digital technologies now.

Speaker 1:

Yeah, I mean, Eric, you and I met actually at an AI conference where

Speaker 3:

We were the only two lawyers we had. We had to find each other.<laugh>.

Speaker 1:

I know, like we're saying that only two lawyers, and we were both wanted to make sure we were sitting in the sun because even though it was in California, I was cold. Um, I wanted when I, I, I know it was interesting, but to, to, to be at that per, to listen to the perspective of these of people that really wanted to push, for example, AI and technology forward, um, both from a physician perspective, but also data science and data, uh, and some he and other healthcare providers. And then sitting there as an attorney and saying, you know, there's, there are, there are barriers that are legal barriers, there are obviously risks and there's tons of opportunity. And a lot of those, um, we, I mean, we're looking at telehealth in a way and, and even just AI being out in the news, like looking at vaccine, um, development, um, and other things that we, I don't know if it would get so much press. I mean, some of it's the perspective of AI and technology that was, um, I guess wor worrying people. I don't know if you're, do you think that this, this, well, I mean, did we push ourselves far into the future? I mean, will we have more data on this? What are you, what are you thinking if you had a crystal ball right now?

Speaker 3:

I, I think we've come to an acceptance of the power of technology, uh, within our lives to both, uh, connect us with each other to facilitate some of our, our daily life. Um, but I think it also, we've understood that you can't just rush into it. Uh, and if you go at it with certain principles in mind, um, you could really effectuate great change. Uh, I just think of how quickly, you know, one of the things we had to deal with was, um, taking our board of directors and our House of Delegates meeting, which was planned in, uh, late April and go virtual. Uh, when we first brought that idea up, everyone's eyes just kind of looked at me and said, well, what about this? What about this corporate governance issue? How do you do voting? What if there's a, uh, proxy vote? All these sort of questions you never now think about? And once we went through a few trial runs, uh, everyone got very comfortable with it. And I, I'd say the meeting went off without a hitch, and you start adding in, uh, what that could mean for regulatory boards, how they meet, uh, how governance is done. I think there's great possibilities that we could be sort of, um, across a certain mental barrier that that had always been there that we hadn't been forced to confront.

Speaker 1:

Yeah. Um, mark, do you think, are there things that you adapted to that you think will go into the future other, whether it's meetings or, um, relationships you've built with the government or other things that you think, uh, that will translate into the future? And,

Speaker 2:

Yeah, I think, you know, again, the nature of an advocacy organization is it, it really is about relationships. And so a lot of those relationships were there. Um, I think you overlay the complexity and stress, you know, of the pandemic. Um, and obviously there's gonna be stress and strain on a lot of those relationships. Um, I think, you know, when you kind of step a couple steps backward and start to look at what's gone on in the last couple of months, um, you know, you're, I I, I think everyone's really trying to do the best they can. Uh, it's just this crisis is really much larger than any one decision maker. Uh, and so, you know, I'm, I'm hoping on the other side of this, you know, we, we, we come together and, and form some sort of, you know, nine 11 like commissions at, at the federal and state levels, uh, to kind of look at what were the successes, where were the failures, um, and, and how do we prepare for this better with a public health response the next time? Because we really need to kind of root things in science and also logistics, uh, logistics side of this. And what I mean by that is, you know, getting personal protective equipment ramped up and, and circulated, uh, not just to the largest hospital systems, but all the way down to the clinic out in a rural community because, you know, this, this crisis has impacted not only urban, but rural. Um, you know, I think there's, there's maybe just one small county that might only have a few hundred people in, in Oregon where there isn't one case, but every other county in the state has cases. Um, and so, you know, it really is kind of figuring out, you know, what are we doing right? Uh, and then where do we kind of fall down collectively, um, and how do we prop that up the next time around? And, and the other thing too that's gonna happen here, I mean, this isn't just, you know, you, you lift an executive order and the, and the light switch goes back on and everything goes back to normal. That's just not how this is gonna play out. Um, particularly for, you know, our clinics and our, and our members, you know, a lot of them have been tremendously impacted. Uh, everyone thinks because this is, you know, a public health crisis, they're busier than ever, and some are, uh, but a lot of clinics are, are shut down. Uh, a lot of folks have been laid off. Uh, and so we've gotta bring those folks back. We've gotta get those clinics back online, but that's gonna take time. Uh, cuz you have to do this safely and effectively, and we kind of know the end point is a safe, effective vaccine, but that's a little bit of an unknown right now, uh, in the interim, until we get to that point. Uh, we've gotta do things that, you know, are about testing and, and containment and, you know, it's a long run back.

Speaker 1:

So, mark, one of the things I I was thinking about was, you know, it's, for example, physician practices. Well, there are physician practices that completely shut down and they're like, we're trying to limit expenses. Maybe they, um, received money under the general distribution, under the CARES Act. Maybe they qualified for a loan. Um, they're, you know, what, whatever they're, they're trying to stay afloat. But if, if ho I'm thinking about hospitals too, or practices that were, you know, tering or distressed already and now we're, we've added this to it. I mean, the doctors don't go away<laugh>, and we need them, even if the practice, like the business, um, can't survive. What, uh, and, and yet hospitals have lost revenue. Like, they're not, I I don't know if they'll be looking to employed physicians. I guess it depends on the, what, what, what happens<laugh>, I mean, or, or what's the, not that you're gonna have this solution because then, uh, maybe you do, uh, but, uh, what are, but what, what do you think is gonna happen to the market?

Speaker 2:

Well, I mean, obviously this is wholly unlike the financial crisis of, you know, 10, 12 years ago. Um, you know, we're looking at a, probably a decade long recovery here, um, from when we start to, to emerge from the crisis. I think there's been a tremendous amount of disruption in healthcare, uh, obviously, and, you know, for, for a state like Oregon that has, you know, kind of an, an urban center, and then much of the state is rural, uh, it's gonna be a challenge to get some of those rural pieces back online. Um, and, you know, they, in a lot of towns in Oregon, the medical clinic really is kind of the, an economic hub, if you will, if you, if you want to think about it that way. They employ a lot of folks in the town, uh, and they take care of the folks in that town. Uh, and so I think we're gonna have to figure out a way to, to support, um, you know, some of these clinics, um, to support some of the rural, um, hospital districts, um, in ways that, you know, might be a little creative. Um, but we've gotta sort of think that through a little bit. And, you know, the thing that concerns us now is that given how many folks have been laid off and are starting to lose their, um, you know, health benefit coverage to their employer, uh, we're gonna start to see some shifting, um, of folks, uh, coming online with a state Medicaid program, uh, in, you know, the numbers, at least in Oregon, uh, that we're projecting are pretty significant. Uh, and we know that, you know, for clinic just to accept Medicaid as a reimbursement rate that doesn't really keep the lights on. Uh, and you know, the thing about healthcare is that the commercial side of that on the health benefit side, really kind of props those clinics up. Uh, and as that revenue declines, uh, and you shift to sort more, you know, federal Medicare, Medicaid reimbursement, uh, it's gonna be even more of a challenge. So, you know, we really kind of need, uh, uh, um, an not only a federal approach. I think they've done some good things at the federal level, um, but we've kind of gotta look at that as well. Uh, and we're not talking just a quick fix, uh, through one bill. We're talking about sort of a long term strategy. And I really think there, there needs to be, you know, task force that are looking at this, um, both at the federal level, uh, with the federal pro payer programs, uh, and then at the state level, uh, to see what can be done not on a, on a sort of 90, 180 day thing, but on a sort of a two to five year plan.

Speaker 1:

Right. And, um, Eric, are you, are there issues that your memberships are looking at as well? And, and how are you thinking they're going to be addressed? I mean, mark talking a lot about<laugh>. I mean, mark has this urban and rural perspective and the perspective of, of caring for communities and sustaining communities even beyond, uh, concept of health, healthcare. And, um, what are you, what is your membership looking at and, and what are you thinking are some areas that that could be addressed?

Speaker 3:

Well, we have a, uh, a pandemic committee now that's been formed. It was actually formed prior to, uh, things getting out of control in, in March where we started with a preparedness, what would it mean for a state medical board to be prepared? And we had some initial guidance, um, really state medical boards have stepped up in, in disaster situations that were localized. Uh, for example, during Katrina or the recent hurricanes that hit the Caribbean, uh, in Puerto Rican, the Virgin Islands, we were able to provide them services to make sure they were fully functional and had their data up and running and could, uh, onboard physicians in a timely manner that were coming in to help but also continue on with their licensing and disciplinary duties. And I think that committee's gonna continue its work, uh, in the next year to just think of what recommendations need to be made to, uh, state medical boards that might, uh, help them be prepared, but also to respond. Uh, but I also think one of the things that state medical boards are going to be focused on, um, and it's, it's been something that's been understudy for a while, is really physician burnout and how this crisis is going to possibly increase the amount of burnout are, are physicians and PAs and, and others in healthcare are doing extraordinary things, uh, under less than optimal conditions and being pushed to the brink as much as every anybody else. And to the extent that, um, there's going to be possible burnout, state medical boards are, are going to be ready to provide those resources. Like I said, they, we had a report last year that was issued at state medical boards, have started to implement some of the recommendations there, uh, on how to reduce the stigma of, of feeling burned out, seeking care, uh, being supportive as a community. And I think, uh, that work's only gonna increase in importance in, in the coming years. Uh, and I, and like Mark, I, I agree that, uh, this is an opportunity to take a, a long-term view of what we want the healthcare system to look like and how it can function, again, taking some of the best of what we had and challenging it to be better.

Speaker 1:

So, uh, Eric, um, one of the things, um, that, um, that I think our audience would be interested in, in learning about too, I know this is in the context of a pandemic, is, is what is it like to be in house, um, and not in a, not that it's not a non-traditional role, but in it's, we often think of, of, um, of a in-house hospital attorney or an health system, um, as a healthcare attorney. And we know that that role's expanded to technology and associations and other, and other places. And as we, uh, as we exceed that membership, expanding it in American Health Law Association, um, what is it like, um, to be, to be in-house and, and, uh, cause obviously your day's gonna be a little bit different than, uh, and issues are gonna be a little bit different than let's say a hospital attorney.

Speaker 3:

Well, I, I found myself, um, really transitioning into a, uh, a centralized hub for our crisis response and management team. Uh, we have several different vi business units that support medical licensing and regulation, uh, be it the assessments side through the US M L E exam, through our, um, credentialing system, through our advocacy arm on supporting our state boards to engaging with federal policy makers. And, uh, being in-house is, is actually a great opportunity to take this role and, and help centralize some of the responses and, and think through the planning, because those departments may have not talked to each other in the past, uh, as well, but they've all had to kind of coordinate through the in-house office. So I can know, I know the personalities or the issues that were, uh, there in the past. And so I've taken on a, a new role. Uh, it's just sometimes I don't even think it's a, it's a legal role. It's just more of a, a team member to, to be a center point, um, and, and help our, our, um, executives make their decisions. Uh, going back to what's made that successful, um, has been really the idea that in, as an in-house council, your job, one of your number one jobs is to get to know those key decision points in each department and their personalities, what they respond to, what they don't respond to, um, and, and be a team leader that way.

Speaker 1:

Yeah, I think when I was in house under, I, I really thought the more I could know about how the business worked or how operations work, the better I could support people. And also, obviously understanding how they responded and taken information on an individual level, which, which now has changed so much, um, being remote and also, um, you know, we're all under some level of stress. There was a article I think I read about even therapists who are help, who generally help people through trauma are realizing that they have the same anxieties and trauma because they're living through the pandemic and they're trying to help their, um, their clients or patients. So it's, it's quite interesting. Um, mark, uh, you know, you and I, when we talked about, you know, I told you about my idea to, to do this to, to look at in-house council in, in a association capacity. And, um, I think I would like to hear what you would like to tell the audience about, uh, what it's like to be in house and an association and, and how that, that may differ from being in house in, in the hospital or other, or other, um, location, like a health system corporate office.

Speaker 2:

Yeah, I mean, it is different. I've, I've always had a connection to obviously healthcare, being a healthcare lawyer, um, but transitioning from private practice to in-house, uh, general counsel obviously is a unique, um, path. Um, it has its challenges. Um, I think it takes probably a couple years to kind of figure out if it's kind of the right role for you. Um, and, and because it is, it is different from just being in private practice where you're wearing your lawyer hat, um, most of the time. Um, and, and you've gotta figure out, um, when are you wearing your lawyer hat, uh, general counsel, um, who is your client kind of thing. Um, and that's always a challenge in a, in a large membership organization, um, like the, like a medical association, um, you know, every, all your, your physician members may think that, you know, you're their lawyer and that's just not kind of how ORs and, and a in an association. Um, but you've gotta balance that sort of legal role, uh, with what I would call the executive role, um, because you are part of a management team. Uh, and you know, there are times when you have to sort of engage in the business thinking strategic, uh, thinking for the organization. Uh, and, and that can be a challenge to go back and forth on that. And then the other unique role in an advocacy organization, uh, is that, you know, I'm a registered lobbyist, um, at the state level, um, and you're engaging in advocacy, um, which for me is, is kind of, it's, it's unique and fascinating, um, but I'm really only part-time at that. We have full-time government relations folks that, you know, you know, are in the, uh, legislative session full-time. And, and I support that. Um, but it is an another, um, unique role, uh, and you kind of wear those different hats, uh, and you go back and forth, um, between them. Um, but, but I've, I've, you know, only a lawyer could say it's interesting. Uh, and it certainly has been, and this crisis really has highlighted sort of all three of those roles, um, for me. And, and, you know, I've really, uh, it's been, it's absolutely been challenging, um, because of this crisis, but, uh, it is interesting for sure.

Speaker 1:

So, you know, I, I think about, um, what I'm working on currently is obviously what other people need me to, cause I, I am in an outside council role now and not an in-house council role, but I, I, the things I'm seeing, uh, lately is thinking about, you know, cares act, uh, compliance and antibody testing and, and also the data that's gonna come out of some of these public health initiatives and what's gonna happen with it, what can be shared, what can't be. These are the things that are right now, I think what I'm are sitting on my desk. Um, is there, Eric, what's sitting on your, your desk and is there anything you're not getting to because you're working on these other things, or, or do you feel like, um, you know, what, what's like the, the issue of, of the day? I know you've talked a little bit about technology and, and licensure and physician wellness and burnout. Uh, is there anything else that you're, um, working on or, or not working on that you probably will be working on when you get a chance to get to it?

Speaker 3:

<laugh>? No, I think, like Mark, um, my role is multifaceted. I, I was, uh, a former lobbyist as well, and, uh, still have that, that advo advocacy expertise or lack of it. Uh, and I've supported our advocacy team on a few different issues. Um, right now, the, the most pressing thing on my desk is, uh, with our HHS grant to improve license portability, uh, how we structure this, what's it mean for data compliance? Who do we tap into, um, the various credentialing rules and regulations related to not only licensure, but physician onboarding for a hospital. Is that different than a telemedicine company? Is that different, uh, than a system? Do they have a specific things to worry about within payment? We want this to be a very streamlined, centralized approach, and you start to untangle one area, then it tangles up in another. Um, so that's been an, an interesting thing to think through, um, and, and work on. I would say some of the things that, um, I haven't gotten to that I had planned on getting to this at least this spring and summer, was, uh, just creating a new contract management system for us,<laugh>, uh, and bringing out to that technology, a lot of it was gonna be done by hand, uh, looking at old contracts that were scanned in that aren't OCR r uh, rateable. And, uh, that that's, it's important, but it's not the priority right now,<laugh>. So hopefully, uh, I can get to that when things slow down or I'll just put my, uh, four year old on it when once he learns how to read and figure out numbers to, uh,<laugh>, file it the right way,

Speaker 1:

Start scanning, that might be fun. Um,

Speaker 3:

He's pretty much better at the computer than, than some of us with his preschool now being on Zoom. So, yes. Uh, he might be quicker than, uh, onboarding an attorney for that.

Speaker 1:

Oh my God, my, my kids are now playing Legos and playing, and I, they were putting cameras on things, and I'm like, why are they worried about cameras or thinking about cameras? And I realized, of course, all their classes are on cameras and they can see themselves for the first time and they're thinking about being filmed all the time. Um, like, okay, um, mark, what, how about you? What's sitting on, on your desk that you didn't get to? Um, you know, and will it wait? And, uh,

Speaker 2:

I think, I think, um, there, I mean, there's, there's a lot of different projects. Um, a lot of the things where we were developing, you know, more compliance resources and, and guidance for our members, that's so important to them. Um, you know, those kinds of things are a little bit on hold. We've kind of morphed our, um, compliance team into, into more of a, a responsive kind of call center where we, you know, we work, work on those gray area issues, um, for practices. Um, we've developed kind of a daily covid briefing that goes to all licensees, not just members, uh, not just MDs dos and, and physician assistants and, and, you know, that are members, but all those licenses in the state just during this, you know, crisis to get the information out the door that, you know, we think is important. Um, so we, we've taken a bit of a broader view, um, you know, during this crisis, and then I think, you know, that might shape reshape how we approach things. You know, on the other side of this, um, there's always things to do in an advocacy organization. So there it is not like there's a lack of work, it's just do you have enough resources to get to it? Um, and that's the, you know, what you have to balance. Um, you know, I could easily employ, you know, four or five attorneys, but that's just not realistic. Um, and so, you know, you've gotta kind of, um, you know, focus on the things that are a priority, um, engage in good strategic planning, which we're gonna have to kind of re redo a little bit. We've just had finished a process, um, in the fall, uh, and we're, we're buttoning up the details of that, you know, for the next, uh, sort of three years of a strategic plan. And now that's kind of, you know, a big pause, button's been hit, and we sort of have to reshape that and get back to it and figure out what the priorities are, um, you know, moving forward. And those, those will shift a little bit, um, because, you know, our timelines for a lot of the different projects that we'd embarked on, um, prior to all this, um, had been on hold.

Speaker 1:

Yeah. So I guess what we should do is look a little bit to the future. Um, I know you both, you know, talked about supporting physicians and through this time who've, you know, are, I mean, we need them so critically. I mean, this is, there's never been a time in our history where we need, needed our physicians and our clinicians. Um, so what do you wanna leave, um, the audience with regarding the, the future? Um, Eric, why don't you start, start.

Speaker 3:

I, I would say that the, the future is gonna be what we are willing to make it and what, uh, assumptions we're, we're ready to challenge, uh, across healthcare, but also, um, the need for improved, uh, improved coordination across, uh, different areas. I think this is exposed, the, the crisis exposed some, some serious, serious flaws that we've lived with and never had to confront. And, um, we can can remake it. And actually, I'm, I'm very grateful to a lot of my colleagues, um, both in the f smb, but, but across the legal community. Uh, we've dealt with many general counsels and advocacy offices in the past, sometimes on good terms, sometimes I'm not, um, where we've all kind of come together on this to work across platforms, work across industries, and share information, share perspectives. Uh, and I think that's something I, I hope is gonna last through this is just a general sense that, uh, with a good community we could really remake, um, and reimagine what we're trying to do and do it for the right reasons.

Speaker 1:

Oh, Eric, that's a great, um, takeaway for our audience. Uh, mark, how about you? What would you like to leave our audience about the future?

Speaker 2:

Yeah, I mean, I guess the first, uh, thing and, and I know this is not easy, um, but sort of, you know, this kind of comes out of working in a home with a family of four for the last, uh, 60 plus days. You know, I, I think you've gotta have a sort of a core kernel of, of hope. Um, I think, um, you know, I feel fortunate to be working, um, in an advocacy organization that supports the, you know, clinicians, many of them that are on the frontline. Um, and, you know, to be able to talk to physicians that kind of understand the science of all this, um, has been hugely beneficial, uh, to me. And, and a lot of the solutions here are science based. Uh, and so I think as a lawyer kind of working in that environment, you know, I've gotta try and be the best, um, most empathetic problem solver I can be. Uh, and you know, I think the other thing that I've gotta balance that with is, you know, how can I be a role model, um, for my kids, um, especially because they're teenagers, uh, and this, this is, this pandemic's gonna shape, uh, the rest of their lives into adulthood. So, um, you know, I think it's really important, uh, to not only be an effective advocate, uh, problem solver, uh, but also, you know, be a role model as well.

Speaker 1:

Uh, mark, thank you for that. I, I feel, I feel the same way you both do. I know when this hit, I having had the experience with pandemics and, and bioterrorism preparedness, I didn't mean to put myself here, but here we were, and I, all I, I thought was, I wanna get this information out because even if it could save like one person's life, those hours will be worth it. And what will my kids say about me when I, when they do grow up and say, what did mommy do during this time? Or what did Daddy do right during this time? And I, I, I, I really appreciate that, and that's why I so appreciate you both taking the time to talk to our audience today. Um, um, please go look at the A H L A Corona virus, uh, re um, uh, hub. There's tons of information there. Um, there's three other GC Roundtable podcasts, there's other podcasts on lots of other really great topics. Go listen to them. There's checklists and articles, so, um, please go there. It's been an in invaluable resource to a lot of people. And, uh, thank you so much for joining us today.