This special series highlights AHLA leaders who discuss key moments in their careers, current and future trends in health law, and AHLA’s role in their professional development. In this episode, Chip Hutzler, Director, Horne LLP, interviews Patricia Markus, Partner, Nelson Mullins, who is AHLA President Elect Designate for the 2021-2022 year (President for the 2023-2024 year). Trish talks about her career in health law, how technology will continue to transform the provision and payment of health care, and advice she would give to young health law professionals.
Trish also tells Chip:
Sponsored by Horne LLP.
To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.
This special series highlights AHLA leaders who discuss key moments in their careers, current and future trends in health law, and AHLA’s role in their professional development. In this episode, Chip Hutzler, Director, Horne LLP, interviews Patricia Markus, Partner, Nelson Mullins, who is AHLA President Elect Designate for the 2021-2022 year (President for the 2023-2024 year). Trish talks about her career in health law, how technology will continue to transform the provision and payment of health care, and advice she would give to young health law professionals.
Trish also tells Chip:
Sponsored by Horne LLP.
To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.
In this special series, A H L A, leaders discuss key moments in their careers, current and future trends in health law, and a H L a's role in their professional development support for A H L A. And this series is provided by horn, which provides proactive guidance and strategies to enhance efficiency, improve patient experience, increase market share, and position you for greater success. Horn Healthcare serves over 600 clients across 31 states. For more information, visit horn llp.com.
Speaker 2:This is Chip Husler. I'm a director with the healthcare team of Horn. And joining me today is Patricia Marcus. She is a partner with the law firm of Nelson and Mullins in Raleigh, North Carolina. And she's also the incoming H L A President-elect designate.
Speaker 3:That means she's gonna be the president in 2023 to 2024. So she's going to be the president of HLA in the year and we're so glad to have her here now several years before to get her take on things. Well ahead of that. And really what I like to start out with in the Trish is ask you how you decided to get into health law in the first place.
Speaker 4:Well, my response to that is probably not as exciting as, um, the response you may have gotten from others. I, uh, graduated from law school and didn't exactly know what I wanted to do. Um, but actually the way I like to tell this story is that when I was a kid growing up outside Chicago and with my dad as a sports writer, I was a huge Chicago Cubs fan, we went to Wrigley Field and sat behind the plate while he was in the press box. And when I was about six, I told him that I wanted to be a cub. And I said, dad, how come there are no girl cubs? And he said, well, Tricia, life isn't fair. Which was a good life lesson. She's a little young for that. But, um, so then because I liked my pediatrician, I decided I wanted to be the Cubs team doctor, you know, cuz it had to be with the Cubs since I couldn't be a cub. Um, so that caused me to go to Haverford, um, college, which was a school that was great at getting qualified students into medical school. Uh, but it turned out after a few years that perhaps, um, I was not such a qualified student, at least in terms of sciences. So,
Speaker 3:Um, is that wallet organic chemistry or something like that?
Speaker 4:It was biochemistry and there's, there's a story there too. But, um, yeah, in any event, so I ended up going to law school and um, thought I wanted to be an appellate lawyer. But, uh, my aunt, uh, who also before she passed away was a leader within a H L A. Nancy Forbes was a health lawyer. And so when I had a couple of, um, interviews with a couple of different lawyers here in Raleigh, after I had clerked for a state judge, I called her and said, what do you do all day? And so<laugh>, I remember writing down this list of things like medical staff bylaws and fraud and abuse and things. I had no earthly idea what she was talking about, but, um, she did, uh, explain to some extent that, you know, she did corporate and regulatory work. And so I muddled through apparently at least one of those interviews because my now partner and then mentor Bob Wilson hired me, uh, back in 1996 to, uh, you know, I knew nothing about health law. We didn't have health law in law school at the time, uh, no health law classes. So it was, uh, a little bit different than it might be for someone, uh, in, in law school today.
Speaker 3:Indeed. Um, that's, that's great. Uh, I actually went to a law school that had health law program in the early nineties, university of Maryland. Um, but I didn't have any idea I was gonna get in the healthcare, so I didn't take any of those classes. And then of course, got it, 20 years later I'm in healthcare. Um, so similar in that sense, but, uh, but I didn't take advantage of what was in front of me cuz I didn't know. Um, did you have people along the way that inspired you? You mentioned a couple, uh, that did and talk about the people that inspired you and what made them special.
Speaker 4:I, I have to, uh, you know, I I will say, um, again regarding my aunt, she was a very, um, a very special person. And, and I think her law partners also would say that she, um, had a, a light around her. She had an amazing voice and I just remember it, it made you feel like she knew what she was talking about, but also that she cared. Um, she had a, she had a warmth about her, but also she was just so smart. And the, the thing that Nancy taught me even before I went to law school when I was a teen and we would talk was that, um, just because you think that the options are all bad, uh, doesn't mean that you can't consider them more broadly and come up with a workaround or a good option. In other words, she helped me open my mind to the possibility that I wasn't seeing, um, different ways of doing something because I wasn't thinking broadly enough. And that was, that was awfully helpful.
Speaker 3:Um, yeah, that's a great insight. And um, and sort of is a good segue to my other question, which is, you know, was there sort of any moment for you in, um, in your career where you you realized, hey, I chose health law and that was the absolute right decision? It was kind of key moment in your health law career when you look back and say, Hey, that's, that's really sort of the turning point for me when I realized I'm in the right place.
Speaker 4:Actually, I, I, I guess it probably would be related to my work on the health information privacy and technology side. Um, I mean, I started out doing healthcare fraud and abuse and frankly I was a baby lawyer when, um, corporate compliance programs were nascent and Janet Reno was the attorney general and, you know, healthcare fraud was the number two priority of the Justice Department ahead of, or just behind rather violent crime. And so, um, you know, I did what lawyers who worked for medical practices and hospitals do at the time, which is, uh, you know, what, what is the OIG gonna look for in terms of, uh, trying to assure that you're not, um, you know, you're, you're billing properly and you're not trying to defraud the federal government. Um, and that was, I mean I, I've, I think that compliance background has served me well. Um, but I think that what made my life sort of my life, life as a healthcare lawyer sort of interesting is when, um, I actually got into hipaa, and this is another one of those things where at the time I was an associate and, um, Wilson, my partner said to me, would you like to learn about HIPAA<laugh>? Because I can't remember if he said, I don't have time to, or I do not care to<laugh>. But of course, as, as an associate at the time, the appropriate response and as far as I could tell, the only appropriate response was why, yes, of course I'd be delighted to. So I did. And for whatever reason, um, it, it ended up being something that resonated with me. Um, I guess because, um, I like intricate in, in some ways I like, I like getting into the details. Um, and I, and I think privacy is important. Um, people argue that we have no privacy. That's probably a discussion for a different day. Um, but I, I think that getting into that, uh, into, um, understanding HIPAA and then related health privacy and security laws got me really excited cuz I, I had a niche, you know, it was something I felt that I could do that was something not everybody could do and not something not everyone knew about.
Speaker 3:Yeah, that's great. Um, what are some of the challenges you faced along the way in how far and, uh, how'd you overcome them?
Speaker 4:Well, that's a, that's a, that's a great question. Um, this is maybe not a health law challenge. It's perhaps a no a, a challenge that lawyers face generally in deciding who they wanna be when they grow up. Um, because I have a compliance background. Um, there, there are, and, and Chip, you know this too, there are different points along your career when you can say, I'm gonna add a skill and I'm gonna drop something else that I do. Or you can say, I'm gonna add a skill and see what happens, but I'm gonna hang on to that old skill because you never know when it's gonna come in handy. And so, um, I have taken the position that, uh, it's, it never hurts to try to keep up on some of the things that you used to do. Where I'm going with this is it's sort of turned me into what I call a utility infielder kind of regulatory compliance lawyer. So I enjoy health information technology and privacy issues. Um, and I work in that area quite a bit, but I also do Medicare, um, RAC and other audits and, and appeals from those. And, um, just regular compliance work. And I work with physicians on contracts and I deal with health information exchanges and accountable care organizations, and I work with licensing of skilled nursing facilities and other, um, types of entities that need to get licensed by the state. And so I, I think that has been challenging in a way because, um, it's hard to keep yourself, uh, up on all of those things. And so you need to surround yourself with people who have complimentary skillsets so that you don't, um, say something really stupid in front of an, an administrative law judge or<laugh> on a phone call with a client. Um, both of which I'm sure I have done. So I, I think just figuring out, you know, what, what's your bandwidth and how do you, how do you make sure that you are giving other people opportunities? Um, and at the same time being the best lawyer and most effective lawyer you can be,
Speaker 3:Right? Well, part of the idea of this podcast is to let you say as many dumb things as possible. So that excellent, this will be the, the worst you've ever done. And then everything else will pale by comparison. But no, in all seriousness, you're doing great. And, um, I think that was a really great answer. Cause that's the challenge a lot of people have is just managing the volume of stuff in healthcare, um, is really tough. I, I find that that's for me a challenge as well. So you've hit on something that hits close to home for me on that one. Um, what's your outlook on the future of health law? I mean, you're gonna step into this role at H L A for the next couple of years where you, you dedicate a lot of your time to the health law bar. What do you see as your outlook of where health law is going? Maybe, maybe that's informed a little bit by where healthcare is going, but, um, but health law in particular, um, do you have a sort of an outlook where you think it might be going and what, what role is health lawyer should be in shaping that?
Speaker 4:Well, wanna dust off my crystal ball, which, um,<laugh> of course is, uh, you know, only good rusty. Yeah, it, it, it it is, it's a little bit cloudy right now, but yeah,<laugh>, but seriously, um, I mean I think that we all expect on the healthcare side for technology to, to continue to be very integral to the provision of healthcare as well as the management of, and the payment for healthcare. I also think that in order to cut costs and make healthcare more affordable, we are all gonna have to get used to the idea that maybe more healthcare is gonna take place in our homes or in a kiosk at a supermarket or somewhere that is not inside of a hospital or another, um, residential facility. Um, in, in terms of where I think health law is going, I think that we're going to have to, uh, as, as those trends become reality. Um, and also I would add as behavioral health, uh, becomes more recognized as integral to physical health and wellbeing, I think that all of us are going to have to participate in developing policies that enable us to, oh, first of all, enable our providers to furnish the right care, use the, the resources that they have and, and the research that they are working on to create new, uh, new therapies that are more preventive in nature. Um, I, I anticipate as is always the case, that the law is going to continue to lag behind the, um, process of creating new therapies. And, uh, you know, a great example of that is artificial intelligence. Um, we
Speaker 3:Don't, yeah, I think that's, that's good point.
Speaker 4:Yeah. We don't know how, how, how do you, how do you, um, how do you govern that? How do you regulate that? How do you, if you ultimately have a, um, a mechanism that learns by itself, how do you<laugh> as a, as a lawmaker or a regulatory agency determine what the parameters where that should be and how do you, uh, implement that? And I, I'm not the tech guru on, on that side of it, so I don't know the answers, but I think we have a lot of interesting and challenging ethical questions that will be coming down the pike.
Speaker 3:That's fascinating. Yeah, I think that's just about right. I, I, the law does lag behind, you know, we had an awful lot of laws come out at the end of last year. They seem to be the catching up on the things we were talking about before the pandemic, right? The price transparency and the privacy law and stark kickback and so on. And um, and now some of these things that have come up during the pandemic, like tele telehealth and artificial intelligence and so on, it's gonna take a little while for the legal scholars to catch up on that and kind of get us there and the government, you know, moves at their pace too. So it's a That's a great point.
Speaker 4:You know, what's what comes after AI and, and when will we be addressing the legal ramifications of that and, you know, the next decade, the thirties? I don't know.
Speaker 3:I I, yeah, what comes after AI is the, the, the machines come alive and take over, right?<laugh>, I dunno, open the pod bay doors, al
Speaker 4:Hopefully not
Speaker 3:<laugh>. Um, anyway, uh, yeah, with, with that transition, um, you know, during the pandemic, we've all been a little bit locked down to some extent. Uh, some people have been a few places I've been one or two, but I haven't been too many. Um, but we all have, as health lawyers have traveled around, I, I dunno about you, but I know, uh, I travel around a bit and I know you do as well. What are your favorite places to visit? I, I have a feeling you've been in places beyond the friendly confines of North Carolina, um, that you like to visit as a health lawyer, probably visit some more and how that you're in this role, where do you like to go for, uh, in your travels along the way, either for fun or otherwise?
Speaker 4:Well, I admit to having a fondness, perhaps an unreasonable fondness for Chicago. Um, you know, I grew up there, I went to high school there. Most of my high school friends still live there. I still do not want to be a Chicago resident anytime between October and May, but I love visiting during the summer months. Yeah. And it's fine to visit in the winter too. Um, I, you know, it's funny because growing up, um, we were a block away from Lake Michigan and so, um, and two blocks away from a beach and, uh, so I felt like I grew up on the water or at the beach and really didn't know much. I always thought I was a beach person. And then I moved to North Carolina and there are mountains here, not in Raleigh, but not far away. And I ended up beginning to travel to places that were more mountainous. And so actually, um, one of our favorite places to go is, um, Washington State, which has of course, uh, the beautiful mountain range between Seattle and, uh, this beautiful lake in the middle of the state called Lake Shalan. And then Walla Walla is also a hilly part of the state in the eastern part. It's, you know, a desert, but the topography is just stunning and they also make pretty darn good wine. Um,
Speaker 3:So that's in Washington State. They sure do.
Speaker 4:Yeah. So that is definitely a favorite place to go. Um,
Speaker 3:Beautiful up there. I, you know, that's another place that's got an interesting topography and, and weather, but it's, um, spectacular. So those good choices for sure. H HLA loves Chicago. We do get to Chicago from time to time and it is fun to visit there. Yeah. Um, I guess we'll be doing the annual meeting there next year and, uh, our fingers are all crossed that will be in person. Absolutely. Um, so as a, as a leader, what have you learned and what would you recommend to, would be future health law leaders? Anything you'd that, if you had a, somebody you were mentoring in health law, leadership, what would you recommend to them?
Speaker 4:Probably that we all come to an organization with our own opinions and our own ways of approaching things. And that is of course, fine, but I think that you learn about other people by being a really attentive listener. And that the way to understand how the dynamics in a room work is by listening. Um, I also think that when you are trying to lead a group of people, if you don't understand, um, the desires of the group as a whole, um, or if there's a specific individual who is in fact running the show, then you're gonna have a hard time being a leader. So I, I think just sort of that, that requirement to say, okay, this is what I think, but why don't I make sure that I'm not the only one who thinks this way or double check to make sure that the reason I'm thinking about this in this way applies in this situation.
Speaker 3:Yeah. Uh, uh, that's great. And somebody once said it to me, and I think it's, it's poignant. It's so sort of similar that age L is a place where you want to ask permission rather than for forgiveness for the most part. Um, you know, both schools of thought, uh, apply at different times in your life, but um, in HLA you're better off to kinda seek, uh, others' views before you march down a road too far. Um,
Speaker 4:I think that's
Speaker 3:All, I think that's what you're saying.
Speaker 4:Yeah, I think that's always a good, um, approach, especially for folks who, um, you know, may have, may be involved in other organizations. And I think each organization has its own vibe and my view is that A H L A is a very welcoming organization and it's filled with tremendous people, um, who are incredibly smart, funny, and very giving of their time. But if I'm new to a H L A, what I would like to know is that these people have been doing this longer than I have and really have a sense as to what works and what doesn't. So perhaps I should, um, you know, just see how things are, are done and rather than, um, you know, stampeding in and saying, I am going to take over this association
Speaker 3:<laugh>. Exactly. Well, um, well there is one more question and uh, everyone knows what it is. I've asked the same one of everyone and we'll see, uh, what your thoughts are on this one. So when they induct you into the Health Lawyer Hall of Fame as a rockstar that you will be, um, what is your plaque on the wall gonna say?
Speaker 4:Hopefully it will say she cared and she made a difference. The older I get, obviously when you're younger, um, you are climbing a, a mountain or a hill and you know, there are things that you want to achieve. Um, and I think your priorities change as you go through life and you have a family and you lose your family members and you know, you get older and you, you start to think, what, what do I want my legacy to be? And I want my legacy to be that people recognize that I cared about what I was working on and I cared about the people that I worked with. And, and that hopefully through that caring and efforts to, uh, demonstrate it and to try to, um, improve the lifes or the lots of my clients or of others at A H L A, hopefully I do make a difference.
Speaker 3:That's, that's a great thing to be known for. No doubt about it. Well, um, thank you for joining us. Really appreciate your having us wanna thank everyone for listening today and, uh, we'll certainly see everyone again soon. Thanks so much.
Speaker 1:Thank you for listening. If you enjoy this episode, be sure to subscribe to a H L A speaking of health law wherever you get your podcasts. To learn more about a H L A and the educational resources available to the health law community, visit American health law.org.