Sarah Swank, Counsel, Nixon Peabody LLP, and Terrence M. Lewis, Senior Associate Counsel at University of Pittsburgh Medical Center, discuss how facilities are ramping up telehealth programs in response to the coronavirus pandemic. From the Public Health System Affinity Group of AHLA's Hospitals and Health Systems Practice Group.
To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.
Sarah Swank, Counsel, Nixon Peabody LLP, and Terrence M. Lewis, Senior Associate Counsel at University of Pittsburgh Medical Center, discuss how facilities are ramping up telehealth programs in response to the coronavirus pandemic. From the Public Health System Affinity Group of AHLA's Hospitals and Health Systems Practice Group.
To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.
Welcome everybody to today's podcast, uh, telehealth and Covid 19. This is Sarah Slink from Nixon Peabody, and today I have with me, uh, Terry Lewis, um, from University of Pittsburgh Medical Center. Uh, Terry is a senior council for the University of Pittsburgh Medical Center, and he is assigned, uh, to work with the Physician Service Division, and he's been there since 2006. Uh, he's also the chair of the Enterprise Telemedicine Oversight Legal Committee, and is responsible for system-wide legal matters related to telemedicine, both domestically and internationally, involving 40 hospitals and over 5,000 employed physicians. Um, he provides legal services to re related to all kinds of telemedicine issues, fraud and abuse, licensure. Um, Terry and I have spoke, um, on in other webinars and, um, presentations. So I'm really excited to have, um, Terry here today. Um, thank you Terry for joining us.
Speaker 2:Thank you, Sarah. And it's, it's very, uh, it's very, I feel very privileged to be able to do this and, and I have to say, uh, this is such an exciting time for telemedicine, given everything that's going on and having spent the last 15 years of my career as assisting U P M C with their telemedicine platform, um, I am sort of ecstatic that we're finally getting a full, robust, uh, health system telemedicine nationally related to everything that's going on with the current COVID 19.
Speaker 1:Great. No, I agree. And that's why this is podcast is really, um, timely. Uh, so just a little background for those that are listening, uh, Congress, uh, passed what was, uh, a stimulus package, which included funding for telehealth and the ability for CMS to waive, uh, some telehealth requirements, which, and then we have, um, some new guidance from Medicare where we'll talk today a little bit about what's happening in Medicaid and commercial, a little bit about what we're seeing out there in the market. Um, so Terry, does telehealth look a little different today than it did a couple months ago for you?
Speaker 2:Uh, absolutely Sarah. It is, uh, you know, telehealth has been evolving as we know, uh, since the early two thousands when Medicare passed the roles and Congress did. And basically it has limped along for a long time. Um, trying to get the regulatory structure around it has continued to evolve. It's created some, it had created some frustration, um, for our providers and for a lot of us that have been living, breathing, telehealth, telemedicine for the last 15 years. And so today looks much different given, as you described earlier, what the federal government has done in the last 10 days related to the expansion of telehealth. On a personal level, I could not be happier that the government is recognizing the value of telehealth, especially to take care of our patients in a time of a national healthcare crisis where not everybody can travel. Folks are afraid to travel. And so I think we're well positioned to help, um, our populations via telemedicine to remain healthy and well. And so it's, it's a very exciting time in the telehealth world. And one thing I will state right up front is, I think that at this point, in this point in history is the tipping point for telemedicine, um, recognition in the United States.
Speaker 1:I know Terry, you and I have been on panels together where we talk about, um, we try to talk about opportunities, right? I think you and I take a very optimistic approach to he telehealth, but there were legal barrier barriers as well. And, um, and we're seeing it seems like some of those knocked down, um, one of the big biggest ones, um, you know, being reimbursement, um, and licensure issues. Um, it's interesting cuz some of the changes that are coming out now clearly are related, um, at least this first wave of, of telehealth, uh, changes, uh, around like people not waiting in waiting rooms. So the idea that the i the people, uh, patients gathering in a waiting room, um, to see a physician could transmit covid 19, are you seeing, are you seeing that change? Are there other reasons why you think this change came at this time?
Speaker 2:Uh, no, I think that's exactly correct. Um, and the change is, has come because I believe the federal government has recognized that we only have so many providers in this country. And the fact that this current virus is very contagious and with all the social distancing and everything else, this is a really good solution to help keep our populations healthy.
Speaker 1:Great. I, you know, it's interesting because when this opened, when my first read this, I, I thought like, you, this is, this is gonna be a big change. Um, and the next thing I heard was that some of the providers of telehealth services, um, were basically having a surge themselves. So they're, um, I'm not sure if you heard about the telehealth surge. Is it something that you experienced? Um, do you believe that there was a, a push towards some of these platforms right away?
Speaker 2:Uh, absolutely. I, I can speak firsthand and say that, um, as of yesterday, today is, is March 24. Yesterday we had over 6,000, uh, virtual visits on our various telehealth platforms at University Pittsburgh Medical Center. And so that surge is absolutely real, and I would think that, you know, similar systems around the country are also experiencing that. I've talked to some of my colleagues on the East Coast and West Coast, and they are experiencing this. And one of the, the things that's really important, I think to recognize is that the technology investments and clinical expertise investments that health systems like A U P M C or Johns Hopkins or U UCLA have made, um, were designed specifically to be able to treat patients remotely, safely and with high quality. And I think that the results, the clinical results when they come in from this surge are gonna be very promising for the future.
Speaker 1:Yeah. So were you able to, do you feel like that certain, uh, institutions were able to scale up for this and um, um, based on the models that they are that you, like, for example, were already in place? Or were there tweaks that needed to happen to the models? It seems like they might, obviously there's screening questions that are, are gonna be different for covid 19, but overall did you feel like you had, like you've had in place what you needed to scale up?
Speaker 2:Um, that's a great question, Sarah. Um, for the most part, yes, we had things in place and we have a, you know, we have probably a more robust platform than, um, a lot of other systems. However, a lot, there's a lot of systems around the country that have outstanding and excellent telehealth platforms. Um, there have had to be some tweaks. One of the things is we've had to add providers that never, uh, provided telemedicine before. Um, maybe they, you know, they had a robust practice in-person practice and now with what's going on with the virus and with concerns, patients have said, look, I, I can't come in however, I would like to schedule a visit on one of your online portals. And so we've had to ramp up some education and training very quickly for some of our providers. We've had to add some technology, but for the most part we were pretty well positioned for this. And from my understanding, a lot of systems right now that might be a little behind the curve are gonna catch up pretty quickly because this isn't a question of when we're gonna do it. This is, is now, we need to do it now. And so I I really believe that the physicians and other providers, um, will embrace this. And you know, at the end of the day, this is the practice of medicine and this is, to me, telemedicine is an extension of the practice of medicine. And so as providers get more comfortable, I really believe that the telehealth is here to stay for sure. And that it's really gonna benefit our populations, not just rural areas. But right now as we're seeing in urban areas, if you look at New York City, um, I have a colleague that works on Wall Street and I don't think she wants to, if she needed to go see her physician now, I don't think she wants to get on the subway or however she has to get there. She would prefer, I'm sure she would prefer a telehealth visit. And not that this is, you know, we're gonna do everything via telehealth going forward after this crisis, but it really provides a delivery option to our patients that is safe and effective. And as the patients and providers get used to it, again, I use the term embrace, I think the country will embrace this as we go forward.
Speaker 1:Yeah, it's interesting cuz one of the things that you heard as a, as a barrier wa was, well, will providers or physicians really want to use this technology? Sometimes you'd hear pushback that they'd rather see a patient in person or patients that say, you know, I'm not used to talking to my doctor like this. Or I just, you know, I'm used to the normal way that I go to the physician, or I just end up not going to the physician that, um, so it may even op end up access to care. What's interesting is, as I was thinking about this, Terry was, you know, for somebody like me and you who go out and talk about telehealth a lot, I realized I never had done a telehealth visit<laugh> when I was going through this. I said, I wonder if I've actually done one. And I I, for all the talking I've done about how, um, vital and important they are to our system, um, it's interesting that I've never actually done a telehealth visit.
Speaker 2:Yeah, no, that, that's a, that's a great point. And, um, I really believe that, you know, you know, you, you think of like your friends and family, um, one person now is, is probably gonna do one or more than that in your group and your social group, and you'll be able to talk and, and digest it. And I think it'll make more folks comfortable because, hey, Sarah had one, she said it went well, why don't I do that? Um, right now, you know, the opportunity's there. So I I think it's a, it's, it's a change in the delivery system of our healthcare, meaning going forward, it is gonna be an integral part of our health system going forward, regardless of whether there's a virus or not. I think folks are, you know, and especially, uh, younger generations are very much, you know, know they want things on demand, but we're also seeing a surge of patients of all ages, um, in all walks of life that are embracing this as we speak.
Speaker 1:Yeah, it's interesting. So one of the things I had heard from talking to, um, people on the industry on the other side are the, the providers, um, that, that provide platforms and maybe have primary care physicians and they, they could not keep up with the demand. And so we see the office for civil rights, um, relaxing the use of Skype and FaceTime, um, which they previously would've said we're, we're not secure and that they would enforce, um, the use of those as, as unsecure under the HIPAA security role. Um, what do you think about that? And then I'm just, I, I was trying to think through what does the future look like? Cause it seems to me ultimately when this is over, you'd still wanna be on a secure, um, site, but understanding now that, that there is such a demand that there may be small physician practices or mental health providers that wanna get to their patients and wouldn't have time to, to sign up. Um, so what do you, what are your thoughts about the, the OCR relaxing enforcement? What do you think that that will look like, you know, um, after this pandemic?
Speaker 2:Well, I, I think it's, I think OCR did a great job with, with relaxing the restriction. Um, especially given the crisis. Uh, most, you know, most platforms, most most health systems physician groups, um, have, if they don't have, they probably will in the future, a HIPAA secure compliant, um, operating system. Um, so again, I think they're giving, uh, this an opportunity for additional avenues for practices and health systems and hospitals that don't currently have, you know, sort of the robust technology. I do think that they will pull back from this after the crisis and go back to, you know, the standard sort of HIPAA secure compliant things. But from what I understand from talking to our technology experts, the technology is, um, more economically feasible today than it was say, you know, when we were doing presentations 10 years ago for ata, when, you know, things, there weren't as many systems, there wasn't a lot of knowledge in this area. So I really believe that over time, now this is gonna open things up. Um, you know, with respect to what OCR has done, I think it's a good thing as long as the patient consents, uh, to the visit, understands that it may or may not be HIPAA compliant and the patient is good to go with it. I think at this point, I think really what the federal government is saying to all of us is, uh, you know, meaning the health systems and providers is please treat our patients, treat our citizens, treat our population as best you can right now given the tough circumstances we're in.
Speaker 1:Right. I know it's interesting because it's, it's the patients and then it's also the healthcare providers as well. Um, one of the things I was thinking about was, you know, the health healthcare providers who may themselves meet criteria to be, uh, vulnerable, for example, maybe where they've traveled their age, a chronic condition, a health condition, um, that maybe, um, would have a difficult time being on the frontline. And I know we're moving, you know, professional staff around too, um, as well. There's the idea that maybe they move around their community or country. Um, it seems like telehealth would be a really great way, um, to put, uh, physicians and others to work, um, if they meet some of those criteria or, or in in fact if they were testing positive and felt well enough to keep, to keep working.
Speaker 2:Yes. And and I another great point, Sarah, thank you. I, I spoke with one of our, our senior lead physicians about 10 to 12 days ago, um, about this whole issue of, you know, if a provider in our group or providers in our group, in our office, um, gets sick, get the virus, what are we gonna do? We have all these patients. And one of the things that came up was, um, obviously being able to work remotely and also with the, and we didn't even know that there was gonna be this, um, OCR relaxation of the, the HIPPA rules. I got the specific question from a provider and he asked point blank if I have to, or if our group has to use FaceTime, things like that, because that's all we have, can we do it? And, you know, luckily the, the, the new roles came, the temporary roles came out. Um, but, but you know, I really believe that this really does create a very flexible environment for our physicians to continue to treat patients, um, regardless of whether they're in the office or not. And it's, it's, I think that flexibility going forward is going to benefit the health and wellbeing of our population in the United States.
Speaker 1:Yeah. And so for those of you on the audience, um, you know, Medicare did not pay for visits when the patient was at home. Uh, it really was very limited, um, related to being located in a rural area in, in a medical facility to receive those services. And the, and, and so this is a huge, huge game changer right now. Um, so what kinda services are you seeing? You started talking about some of those, are you, you know, one of the things that I thought was interesting was, um, the focus on mental health services. Something that I think other, uh, uh, you know, having, uh, had clients in the past that were doing telepsychology and others, um, trying to get those launched, uh, social workers, to me it seemed like a really big acknowledgement that there were especially vulnerable seniors who either had existing mental health conditions, um, may have them because they test positive and may need services, or from the fact that we're a lot of, uh, people across the country are at home either, um, with stay at home orders or, or or otherwise, um, have anxiety or stress around the current conditions. Um, it seems like mental health was, uh, something that CMS acknowledged. Is that a service area that you've seen as well? Is that one of the areas that you guys are exploring?
Speaker 2:Yeah, Sarah, absolutely. Our behavioral health team, um, here at the University of Pittsburgh Medical Center, they were one of the first groups, specialty groups to reach out to me. We've got a fairly robust telepsychiatry program already set up, but their volumes are spiking. They are using it, and it's a critical, critical need. Um, it's hard enough, as we all know, there's a lot of stigma around behavioral health services. It's hard enough to get patients to come into the office, uh, when they need care and, you know, counseling, things like that. Um, but the telehealth aspect and what we've seen so far is patients are even, you know, are much more comfortable from, you know, working from their living room and being on one of our portals, being able to be seen by their provider. So I think behavioral health, this is a huge thing where we may now in this country, be able to get access to a lot of patients that need those critical behavioral health services. In addition, besides the standard PCP services that we're seeing now online, and I'm talking about a common cold, or do I have covid, you know, whatever, we're seeing a lot of pediatric telemedicine because again, um, parents are fearful to bring their child into the hospital if they don't need to. So we've been able to triage a lot of those patients as well. And for the most part, a lot of them can stay home. Maybe they need a prescription, maybe they need this or that. We're able to, to direct those patients and treat them online. We've also had a surge with respect to post-surgical, post-procedure, uh, patients. For instance, if I had hernia surgery 10 days ago and I was supposed to have a follow up, just say this week, we're now able to treat those folks online. And again, it's based on if the patient's comfortable and the provider's comfortable. If there's an issue post, post-surgical, post-procedural, and the patient has to come in, they have to come in. But for the most part, we're able to do a lot of those visits now, um, remotely on one of our online portals. And I, again, I think it, this flexibility, uh, you know, really goes both ways, both with our providers, uh, to be able to schedule these visits and maybe, you know, the provider is at the office today from nine to five, but can do some of these in the evening or early morning. And then definitely for the patients, like for instance, in, in Pennsylvania where I'm sitting today, and I know a lot of other states are in the same situation, you know, there's a lot of emergency orders by the governor's office about restricting travel and social distancing. And even though you're certainly entitled to, to seek medical care at any time, um, I think this makes folks more comfortable being able to use a platform to be comfortable. So, you know, I I really think that, again, this creates some good flexibility, uh, for our patients. And, and basically, I mean, I could go through a list of all the different types of specialties we're doing, but I got, um, an email this morning about we have ortho patients, you know, patients that have had recent like shoulder surgery or knee surgery, we're able to put them on the platform live audio video, it is, our systems are hippa, HIPAA compliant. And again, if the patient does need to come in based on the visit, they will come in. But for the most part, we're able to keep them at home, you know, make recommendations to them. So I, I think it's sort of a win-win at this point.
Speaker 1:Yeah. And so, uh, I, what's interesting is I was reading about, for example, there's opiate treatment centers and the use of telehealth. And so it seems, um, because we don't wanna put maybe people into centers altogether, and so they're trying to look at stabilized opioid patients, and I believe Pennsylvania may even have its own initiative around that. Um, the other thing I was thinking about is, uh, what we call traditional telemedicine, which TE or telehealth, which tells you how long Terry, you and I have been doing telehealth. Um, so the idea of the telehealth in the hospital, uh, one of the things that first hit me when I heard this, and it was looking down the road quite a bit, was the idea of tele icu. So I remember, gosh, years and years ago, setting up some of the, some fir of the first tele ICUs, um, with command centers and wondering whether those types of programs maybe, um, helpful if we do have the major surges that are, are currently being predicted, or if we're having ppe, uh, e uh, shortages, mask gowns, and so on and so forth, would there be a way with really specialized physicians to be sitting in a command center helping across the country? Is that something that you've thought about, looked at, and um, or is it something that you would be interested in exploring?
Speaker 2:Um, I can definitively tell you that we are working on that initiative as we speak, and it wasn't related to Covid 19, but the fact that we have critical care, med medicine specialists, hospitalists, and other folks, um, that can, we're, we're building a platform, um, where we will have certain services related to the ICU provided by telemedicine as we move forward. Um, and one of the, you know, prime examples of why we're doing that is because of a physician shortage. We have about 35 or 40 hospitals within our system, plus we also partner with many community hospitals in Pennsylvania and some of the, some of the locations. It's very tough to have, uh, the specialists there on site, and maybe if they are on site, they might only be there from say, eight to six. So tele ICU is sort of the next, um, big thing. There's gonna be a surge of that because the specialists are very comfortable, uh, at least hours are right now. And I know other folks are too, are very comfortable with the clinical protocols and being able to treat and monitor patients remotely, um, that are in an icu. It's never going to, you know, it's never gonna be a fail safe thing where everything is perfect. However, in the long run, this will cut down on costs. It will, it will save Medicare money and other, other federal health programs. And again, once the specialists become comfortable with it, I think you'll really see a lot of that. So I appreciate you bringing that up, Sarah. That's a great example.
Speaker 1:Yeah, I'm hoping that, um, as we're saying this, but they're either like academic medical centers such as yours or other big rural hospital systems that had have started, or these programs or thinking of starting them, you know, this would be a good time to, to either look at expanding them or developing them, or if you're in an area where you think you could use, help, reach out to one of these programs that just, it just, it was one of the first things that hit me as, you know, what can we do to prepare for the future. Um, so, you know, we are looking at, we've talked a lot about Medicare and you know, look, for those of you listening, look at the, the Medicare, um, expansion. There's three types of visits. There's codes for them, they pay like an office visit. Um, are you seeing commercial payers, uh, Terry, cause I have, they're starting to look at coverage for telehealth services. Some of them had them already. Some of the employers had telehealth services, um, some Medicaid programs had head telehealth services. Are you seeing an expansion not just across obviously Medicare with the waivers, but across all types of payers?
Speaker 2:Uh, yes, we are. Um, and I, and I'll give you a couple examples, Sarah. One is, um, like Pennsylvania, Medicaid has, um, they for years have had a telemedicine program and they have even relaxed, uh, similar to the federal government, have relaxed certain restrictions related to that, all the way to the fact that you can actually have a telephone call, um, with your MA patients and treat them. Now, again, that's not traditional telehealth, but they have, um, really gotten involved in this knowing that our Medicaid population, how important it is for these folks to get treatment. Um, with respect to the commercial payers, yes, as well, we have seen over the last 18 months, uh, many of the commercial payers that we work with or enrolled in have telemedicine, uh, services provided and, you know, are covered. And I think after this whole crisis is over, let's say, whenever that is, you know, in the future over the summer or whenever, um, I think that you will see a lot of commercial payers, if they don't already have these services, um, within their provider agreements, that they will be adding them quickly because I think they're gonna recognize similar to the federal government, the value, uh, of the clinical care and the cost that can be saved. So we're looking at that closely. Obviously reimbursement is a, a very difficult issue within telemedicine, um, because every payer, as we know, can be different, but as long as Medicare continues along the road that it is, uh, with expansion and relaxing things, I know some of this stuff's supposed to be temporary, maybe some of it'll become permanent. But either way, I think that the commercial payers do not want to get left behind because if you have, you know, three or four dominant commercial payers in a state or a, or a, you know, a large metropolitan area, you're not gonna want to be the, the payer that doesn't recognize these services, um, for your, uh, subscribers.
Speaker 1:Yeah, it seems that the, the payers and actually providers will have more data about the efficiency and effectiveness and quality of, of, um, services given that it's in a, a different context. But there will, with this expansion, there seems to be, there might be a way to have a evidence to show that it, that it works or that people may, that people were, um, accessing it and, and were, and were using it. Um, one of the things that we talked about in the beginning, and I I heard you talk about this too, is sort of what are the other, you know, I said one of the things that was another barrier was, uh, payment. One was payment and one was licensure. Um, and so you said that you're, you know, looking at doctors who never had used telehealth before, are you expanding your network to other physicians? Um, are you having to credential other physicians? Are you, are, are you dealing with licensure issues across states? Um, so one of the things that came out with the CMS waiver was it talked about licensure. And it was a, it's a little confusing because as you know, CMS can discuss licensure as a requirement, but at the end of the day, licensure is a state state issue, and we're seeing states like Connecticut and other states, um, loosening, uh, licensure issues even around telehealth. Um, have you looked at, are, are you adding positions? Are you thinking about credentialing or licensure issues with your physicians?
Speaker 2:Um, yes, absolutely, Sarah. Good question. Um, with respect to provider licensure, um, you know, the, the, the Medicare, the 1135 waiver really relates to payment terms related to treating a patient that is a Medicare patient across state lines. It doesn't give a blanket waiver that you don't need a state license. It's just that they're not going to consider that as part of the pa, they're not gonna hold that against you. However, that's my understanding. But however, um, yes, we have, we already have within our health system, we have credentialed and, and um, obtained licenses for various states surrounding, um, Pennsylvania. Um, we have not added, per se any new physicians yet, uh, because of this crisis. Um, so we are closely, and what we're doing is closely looking at our surrounding states and other states that our providers have patients, um, located in those states. Um, as you know, many of the states, like you mentioned Connecticut, and there's a whole bunch of them now that are issuing emergency declarations regarding licensure during this crisis. My advice though is you do have to look at each state, state by state specifically because there are different requirements. Some states are saying, just go do it. Other states are saying please register or fill this paperwork out. Um, so we're, we're getting our hands around that. That is a tricky issue because as we know, um, provider licensure is very personal to the provider. The provider is subject to the state, uh, board of medicine, each state's board of medicine's roles. And you also have, just to add on the licensure, the whole issue of malpractice insurance. So even if the federal government could have, uh, worked with the states in advance and said as part of this 1135 waiver, we have assurances from all 50 state medical boards that they will not enforce, you know, unauthorized practice of medicine. If you don't have a, a license in their state and you're treating a p patient via telemedicine, you still have malpractice requirements in every state. And they do vary from state to state. I mean, I know that Pennsylvania's different than West Virginia is different than New York and Ohio. So that's something to keep in mind too. Um, you wanna make sure that, you know, you're checking, your clients are checking with, uh, your insurance to ensure that, uh, you can do this. Cuz that is a, that's a tricky thing. And if you do not have insurance and there is, you know, a potential bad outcome or a lawsuit, uh, that could be a problem. Given all that though, um, those issues can be overcome. There are solutions to all of this to provide malpractice out of state for your providers, given they follow all the other roles. So I, I'm trying to keep everything on a, I guess I'll call it the glass half full, um, and say that, but, you know, there's a lot of, a lot of issues, but that's one that, um, you know, to be aware of.
Speaker 1:It's interesting. So I think some of the, I think that's a great issue to bring up. Uh, and, and I think a lot of these arrangements, whether it's telehealth or otherwise are, are coming fast and furious as people are trying to get ready. And I've even seen some really altruistic arrangements that are coming forward, um, looking through how to set these arrangement up, up, it seemed to me that, you know, putting some context to it, whether it's in a recital or exhibits or otherwise, um, you know, to try to try to document in some way the what was happening at the time, the intention of the parties seems to be, you know, the, one of the ways to move these things forward without over wiring it in a time where we don't necessarily might not have days or weeks or to review contracts, and we may need to have things moved at Mount, moved out quickly. Um, do you have any other tips for, um, contracting or partnering with AMCs during this time? Uh, active medical centers?
Speaker 2:Uh, yeah, absolutely. I mean, I, I, you know, for, for our purposes, I mean, I have many, like, I'll call them contract templates and things like that. Um, at this point, you know, the main focus is on, you know, who the providers are, where the patients are, who are the patients, patients of who's gonna, you know, ultimately store the medical record, who's gonna do any billing. I think if you get those basic things attached, and again, we, we always have the fraud and abuse roles that they consider as well. I think you can quickly develop these contracts, um, pretty mechanically and get them done. Like you said, we don't have weeks or a month or whatever. Um, you come up with the basic terms and the attorney puts it together. And again, it doesn't have to be too complicated right now, do the best you can with it. You can always go back later and adjust some terms and things like that. Um, but what what is important is, you know, it security, the medical record, the billing, things like that, and just the clinical protocol. And that can be a one page. I mean, you can simply, you know, for instance, if a hospital right now wanted to, uh, you know, an independent hospital wanted to contract with us just to have consults to discuss anybody who came in that may have covid 19 symptoms, it would be pretty straightforward. I would go ahead and reach out to one of our providers that's involved and say, just give me the bullet points of how the clinical protocol's gonna work, audio, video, you're gonna see them within 15 minutes of when we find out about it. Um, and here's the assessment you're going to make.
Speaker 1:Yeah. So it seems, yeah, it seems like this is not the time to, you know, have the contract set on your desk for a week while you're trying to figure out how best to do it. Um, but, but getting the basics down. I know there's a waiver potential 1135 waiver for, for Stark. It'd be interesting to see how that works. I've heard, um, people ask around the Anna Kit back statue, and we'll be, I'm not sure what will happen with that, but it seems since the, a kickback statute's intent based, uh, documenting the intent of the parties at the time to show all good intentions, I think would be helpful. I mean, there are fraud scams out there right now. We've got fake hand sanitizer and people showing up in hazmat suits at people's houses and saying that they're going to like clean their house and then steal from them. So there are people that take advantage of these times, and it's not that we won't see potential fraud, but for those providers out there attempting to put something together in in these times, uh, it just, it just strikes me that having, having them tend of the parties and some basic terms seems, seems right to me. Terry.
Speaker 2:A absolutely, and, and, and, you know, at the end of the day we're, we are in a national healthcare emergency crisis. I mean, this is, these are unchartered territories. Um, the best thing I can say is do everything in good faith. And, you know, at the end of the day, not everything might be perfect. Um, but at the end of the day, what, what is our ultimate goal? Our ultimate goal is to be able to treat our patients, our population, to keep them healthy, to triage them if they have the virus, things like that. And at the end of the day, I really believe that, you know, there'll be some forgiveness here as necessary.
Speaker 1:So as we transition from, you know, the pandemic and, and, and optimistically looking forward, what do you see as the future of telehealth after Covid-19?
Speaker 2:I, I see the future being very bright. Uh, I believe that there will be a tremendous amount of clinical literature about how health systems and providers, uh, deployed telemedicine, what their clinical results were, how the patients liked it. And I do believe that ultimately this, while it's a pandemic, and we hope it goes away like tomorrow, uh, this pandemic has essentially cast telehealth into the future. Meaning it's not going away. It's only going to grow. And the recognition, again, by the federal government, I think is so important because of the funding that the federal government provides our population for Medicare and Medicaid, and the folks that are, are watching this, um, are gonna see some really good clinical high quality success. And I think that it will sell itself for so long. You know, we, we've talked to folks at the federal and state level about telemedicine, and I think everybody's like, that's great, it's new. And you know, someday you'll have universal reimbursement and universal licensure. I'm not saying we're gonna get all that immediately, but these building blocks are the best thing that could happen for telehealth, um, in the last 15 years. So I, I feel very positive about the future, and I'm frankly very excited about it because we are gonna continue to see new roles and new challenges, but we're gonna find solutions. And at the end of the day, folks will in fact, embrace this, both the patients and the providers. And to me, the, the one thing I would, would sort of end with is there's no going back. Now, the toothpaste is out of the, the tube and telehealth is going to march forward, um, for the rest of American and world history.
Speaker 1:Thanks, Terry. I know this is, um, I think we've, we've for years been working on these, hoping that there would be something that would move it forward. I don't think any of us wanted to be in the situation we are, but the situation has provided what is, what is amazing about our healthcare system and what are some opportunities or what is broken in our healthcare system. And this seems to me like TE is a real opportunity. So, uh, Carrie, I really wanna thank you for talking with us today about, about telehealth.
Speaker 2:Sure. And I, if I could add one last thing, Sarah, one of the thing, you know, a lot of the folks that will be listening this, um, are attorneys or hospital administrators, things like that. Um, one of the most important things that I learned, um, over the last 15 years, uh, of being involved in this space, uh, as my primary job as an attorney in-house, is to have really good legal counsel and outside counsel. And, you know, Sarah and I have talked Sarah, you have a great firm. There are not, I I have to say this, this area is under lawyered. So find good lawyers like Sarah because these issues are important and they're gonna be more significant as we go. And, you know, general practitioners and things, it's hard to learn this space quickly, and a lot of clients are gonna want quick answers. And they, and I know my, my client itself, they, they want immediate answers, not quick answers. But, you know, having good outside consult that you can rely on is extremely important in this area.
Speaker 1:Oh, Terry, thank you so much for that. Um, thank you everyone for joining us today. Um, we have more information on the American Health Law Association, um, coronavirus hub, and that's right. We, American Health Law Association is rebranded and look out for those new logos. It's was really, uh, it cool to see that come out, uh, recently as well. Um, so thank you all so much again for joining us, um, for more information, more podcasts coming your way. Thank you.