AHLA's Speaking of Health Law

GC Roundtable: Caregivers During the Pandemic

July 13, 2021 AHLA Podcasts
AHLA's Speaking of Health Law
GC Roundtable: Caregivers During the Pandemic
Show Notes Transcript

Sarah Swank, Counsel, Nixon Peabody LLP, speaks to two GCs about the role of caregivers during the pandemic, the challenges they are facing, and how their organizations are providing them with the support they need. They share stories about caregivers they have interacted with and how those experiences have inspired their own careers.

Sarah’s guests are Michael Herald, General Counsel and Chief Administrative Officer, Guardian Healthcare, and Terry Lewis, Senior Associate Counsel, University of Pittsburgh Medical Center.

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:

This episode of A H L A speaking of health law is brought to you by A H L A members and donors like you. For more information, visit american health law.org.

Speaker 2:

Hello everyone, and welcome to today's latest GC round table. Um, I have with me two guests, um, Michael and Terry. I'm gonna have them introduce themselves. Um, Michael, why don't you introduce yourself first?

Speaker 3:

Sure. Good afternoon, Sarah. Thanks so much for having me today. My name is Michael Harold. I'm the General Counsel and Chief Administrative Officer for Guardian Healthcare. We, um, operate about 55 skilled nursing facilities and a handful of assisted living or personal care sites across Pennsylvania, Ohio, and West Virginia. I've been with the organization for just shy of five years and, uh, have responsibility for helping out with obviously, uh, legal issues related to, uh, that face our organization. And then as the C A O I also provide support to our payroll team, our it, uh, group and team, uh, and have some responsibilities with respect to human resources, uh, for the organization.

Speaker 2:

Great. Thanks Michael. And Terry, why don't you introduce yourself to the audience?

Speaker 4:

Sure. Thank you Sarah and Michael, and this is a real privilege and honor to be sharing the stage with you guys this afternoon. Uh, my name is Terry Lewis. I'm a Senior Associate Council at University of Pittsburgh Medical Center, located in Pittsburgh, Pennsylvania. I've been with U P M C for about 15 years, and I'm responsible for the health systems, uh, telehealth platform, as well as all federal and VA contracting, as well as several other, uh, areas within U P M C, including physician contracting. We have approximately 5,000 employed physicians in 40 hospitals across three states. And as you can imagine, we're all been very busy. Um, but with the, and I'll say a little bit about telemedicine later, but having had been through C O V D, uh, with the telemedicine and having worked on our platform for 15 years as their senior legal consult through blessing, uh, to have that ready for our patients. So there'll be more of that later, but thanks, this is exciting.

Speaker 2:

Great. Thank you. And I'm Sarah Swank, um, from the law firm of Nixon Peabody in the Washington DC office, and we're gonna get started. So, so let's talk Terry, what don't you just said,<laugh>, which is, you know, it's, uh, here we are in, in the beginning of, uh, July, 2021, and we've all, all been through a lot and we've, uh, watched caregivers go through a lot. We saw in the beginning, you know, on the news and otherwise, and, and in our communities, people, you know, doing honking, honking horns for our caregivers and, and trying to support caregivers. There's been a lot of talk about burnout and caregivers. Um, what do you think, like, what, what do you think, uh, about the role of caregivers, um, in the, in during this pandemic and, and your support of them through U P M C?

Speaker 4:

Uh, that's a, that's a great question. I, I really feel like our caregivers, providers, um, just really truly, uh, went above and beyond the call of duty to ensure, uh, patient care continued for all of our patients in, in a very difficult situation. And for example, as I mentioned earlier, the telemedicine was a huge part. We had gone from about 250 patients a day that we were treating via telemedicine pre covid to over 10 to 12,000 a day once Covid began. And, you know, a lot of our providers had not used our telemedicine technology before. And it was just amazing how quickly our providers were able to pivot to the digital environment to help all of our, our patients. That doesn't mean we didn't do a lot of in-person too. I mean, obviously the emergency rooms and, you know, surgeries that had to go forward and, and trauma, things like that. But I, I just, you know, the, the words I use Sarah, is collaboration and dedication and teamwork. It was, it was really fabulous to see. It was very moving and, you know, being in, we're all in healthcare here and, and all, obviously our audience is too. Uh, it was, you know, just something where you feel like, okay, I've, I've been an attorney, I've been working a long time. I'm in law, in healthcare. And, you know, you really see, you got to see truly how important our roles are to support our caregivers and clinical networks. And I just thought it was fabulous. And, you know, there, to me, there's no going back. We can talk about that later. But, uh, just really amazing stuff. And I'm just, I'm so proud of so many people at U P M C and nationwide. We, you know, around the country, all of our colleagues, everybody stepped up and, you know, our patients were able to adapt as well. And we've had great quality. So, thanks. That's a great question.

Speaker 2:

So, Michael, going on that theme, you know, when you, you and I started talking about doing this podcast, I think we had something in common with what Terry was saying was, which was, you know, this important story of the caregiver and, and, and the role that they played, uh, and how that influenced organizations and communities. Um, what, why don't you tell us a little bit about your perspective on, on the story of the caregiver and why they were so important?

Speaker 3:

Yeah, thank you. And, and really it echoes a lot of what Terry said, but, um, and I think he said it very well, that really our caregivers and and caregivers across the country really were the heroes of, um, this unfortunate situation. And many people, um, saw on the news and in other ways, um, the devastation and the impact that this pandemic had on skilled nursing facilities, other healthcare providers, other types of providers, hospital systems. And I think that our caregivers, a guardian caregivers across the country, really, I think stepped up in a way that I is sometimes unimaginable when you, when you think back on what was happening, um, a little bit more than a year ago now. And a lot of it was really just you could see their, their true just human elements coming out and, and that compassion that they have for other people that's displayed in the work that they do. And by getting people, um, many of whom are, are vulnerable, um, individuals because they have, um, health issues, physical, mental, behavioral health issues, um, that really just provided that system of support for those individuals during, um, a healthcare crisis that we haven't seen in for over a century, um, and that none of us have ever seen. Um, w was really just truly remarkable. And we have tried, uh, as often as possible to celebrate, um, all of the great things that our caregivers did. Um, I remember at one point hearing when one of our sites had, um, the virus, uh, had an outbreak of the virus that, you know, there was a, a caregiver who found out that a resident who was, um, unfortunately passing but didn't have family that could be there at the time, she found out that the resident really her favorite singer was Elvis Presley. Um, and so this caregiver, uh, happened to play the guitar and, and could sing. And so she just spent time, um, with that resident, um, at, you know, that that transition of life and, and sang, um, Elvis tunes, uh, to her. So, uh, I think just examples like that really, um, demonstrate that level of compassion of going above and beyond providing medical care, healthcare, um, and just connecting, uh, as people and our caregivers really were an example to all of us, um, through that time and in, in that period and, and continue to be, they continue to come in and, and face new challenges, um, that, that we still encounter, uh, every day. And they do it with always with Grace. So,

Speaker 2:

So Michael, one of the reasons why a, a lot of US health lawyers, uh, went into health law was, was to support patients and and caregivers, like at the core of it, right? And are there, you know, how have you been inspired by them and do you still continue to be inspired by the caregivers? How does that fit into your own career path and, and your own, I guess, satisfaction with your, with your job?

Speaker 3:

It's become a part of daily life for me, Sarah. Um, and I think the, the impact that it's had is that it has enabled me to really stop at certain times and think beyond legal issues, business issues that I might be working through and remember what happened over the last year, and think about the individual who may have to live with the decision that we're we're facing as an organization from, from a legal perspective. Um, and I think that has been one of the greatest benefits, um, not only to me as, as our organization's lawyer, but I think to many of my colleagues, um, whether in compliance operations, you know, other areas, finance. I think because we did our best to support our caregivers during that period, it has really given us an opportunity to focus on making sure that all of the decisions that we face keep that in mind. Um, the importance of, of making the best decision in light of the caregiver experience and the work that they have to do and, and, and the situations that they encounter daily. So it's almost become part of my routine now in, in decision making, just trying to think about, um, the real impact that a decision could have, um, and how that might impact someone who is providing that care that, that, you know, we strive to make sure is as quality care, it's the best care we can, we can get. And, and our caregivers do that all the time.

Speaker 2:

So, yeah, it's something I know that's been a driver for me and my crew, both as in-house council and, and outside council, some as a in-house council. You, you've, um, can see that impact and especially as, you know, some of the people that are, and you know, the stories, like you said, Michael, but also know the actual people that are out there, um, giving care in a, in a, like you said, in a human way, that it can be very compelling to keep going and supporting them, uh, right. Uh, so Terry, how about you? How does, how has the, you, you and I have known each other a long time and I know you've, um, supported physicians and, and this, this concept of, um, technology enabled services and this evolution over these years of, of that, how has that the role of the caregiver inspired you in your career?

Speaker 4:

It, it's, it's another a great question. And, and what's amazing about it is, um, the hearing, the stories about how our caregivers have been able to help patients during a very difficult time and, you know, seeing testimonials from patients and the caregivers, um, has really just, to me, it reinforces the importance of our work as, as, you know, legal cons in-house and, you know, outside console as well. But it really just meshes so well. And I, I'll give one example. Um, when Covid got underway in the spring of 2020, um, you know, some places were hit harder than others. New York City was one of the hardest hit, and their ICUs were obviously overrun and things like that. They just, you know, there were so many patients that that got the virus. And so they, uh, one of the hospitals, Mount Sinai in New York, um, reached out to our tele I c U group at U P M C and we were able to help them through, you know, telemedicine to help them, triage and manage patients. And, you know, we just came up with like a memorandum of understanding, you know, I, you know, license, we could talk about licenses and this and that in a normal world, you know, you gotta follow all that, but it needed done and we were all behind it. Um, legal compliance and obviously the clinicians. And what ultimately occurred is, um, I, you know, a couple months after that and things had calmed down, although it's, you know, been up and down the, uh, I opened up the paper and the, the newspaper only, uh, I think it's like three or four days a week, it gets printed here. But I've had it forever. Cause I'm a big sports fan, I guess. But, um, open up the paper and there's a huge ad from, uh, Mount Sinai thanking U P M C and its clinicians and staff for helping them manage that situation. And, you know, and other folks commented about it to me, and I just felt like, you know, I'm part of the team, part of the collaboration, and just so glad that our physicians and all of our providers, our nurses, staff, everyone, um, it's just very gratifying and it, it makes you, you know, I'm more energized than I've ever been, uh, for the future of medicine, including telemedicine, because there's so many more great things we can do, and our clinicians are coming up with new ideas, and it's just great to be part of it.

Speaker 2:

Yeah, it, it's, you know, it's one of the themes that's come out of this podcast and, and talking to people, this idea of collaboration that didn't, that existed maybe with the clinicians and somewhat, uh, among lawyers and others, but just this next level of collaboration, um, that, that people hope, you know, sustains itself the idea of like, the positive changes in innovation that would, would happen, um, as well. It's, these are very common themes. I think the worries that we've heard as themes have been around, um, like burnout and, and, and, and whether or not those type of like, you know, emotional wellness of our providers, um, that have been through something rather traumatic, uh, and, and how we support our caregivers, you know, through these kind of more, uh, difficult, you know, times. And, and some caregivers really do, they have, uh, post-traumatic stress, they, um, are tired. They've been working long hours and, and ensuring that, that their wellbeing is, is part of the thought process on, um, ensuring that, you know, you're, that healthcare moves forward. Uh, and there's, there are some concerns that I, uh, you've probably heard as well around, you know, people wanting to retire early or who left healthcare and may or may not come back to it after this experience. Michael, how, how has your organization, or how, how do you feel about supporting caregivers that, that really have been through a tough time and ensuring that they, you know, continue on and, and how that may impact, like future, future staffing or, or future, the future of healthcare itself?

Speaker 3:

That's a great question, Sarah, and it's one that, is it front of mind for our organization, um, right now, because we are seeing a lot of the impact, um, of the pandemic with respect to just the, the toll that it takes on, on caregivers, on people, right? Residents, caregivers, families, and Guardian has really, um, you know, we have been working hard a as a team to try to find opportunities to support our caregivers, um, with, um, however the, the, the experience or the pandemic might be manifesting itself. So, you know, we've seen articles, I've, I've read articles from the New York Times about this concept of, um, people languishing, uh, coming out of the pandemic in terms of use. You used, uh, post trauma, traumatic stress, um, certainly just, um, a variety of ways in which the experience of the pandemic is now manifesting itself in people, and particularly in, uh, caregivers who were at the bedside and saw a lot of things that, uh, I don't think they would have to encounter and worked a lot of hours, um, more than expected, more than they already do. This is already an industry where people work long, hard hours. So, um, we are focused on really finding opportunities to make sure that people have support, um, when they're in our sites or when they're at home. So we've found, uh, you know, benefit programs, perk programs we're looking at right now, opportunities to provide those sort of at home out of work support systems for people, whether it's, um, you know, uh, cleaning services at home. I've, I've had actually a lot of, um, caregivers a ask me if we could find good grocery delivery services for them. Many of our sites are located in rural areas in Pennsylvania and Ohio, and so it's hard to get, uh, groceries, uh, get to the, find time to get to the grocery store or get a grocery delivery service, something that, um, folks in cities might take for granted now. Um, so we look at those things. And then even within our sites, while people are at work, um, we always are trying to find opportunities to make sure that there's time just to, to even talk and have discussions. And when people need emotional support, we, we have a great assistance program to provide them that support, um, sometimes out outside of the site, sometimes at the site. So, um, it's really been a focus for us. And I think you're right. It, it's, uh, so glad you raised that interest here with Tes to say too, because it's something that I think, um, really is critical in moving forward and, and turning the corner on the pandemic now is making sure that we've done our best to support these people who gave so much to our residents.

Speaker 2:

So Terry, what are your thoughts on what Michael said about, um, supporting caregivers and what are some of the ways that your organization's been supporting caregivers or, or ideas that, or you've been thinking about?

Speaker 4:

Yeah, and it's, um, and I, I really, Michael, you know, hit the nail on the head. It is about, you know, you have to have a plan to care for your caregivers. And, you know, his organization has a very good one. And, and they, you know, let's be honest, I mean, the nursing homes are dealing with the most vulnerable populations, and so it is difficult on any given day, but let alone with everything that happened in Covid. So, you know, at U P M C, what we've really tried to focus on through, you know, teamwork and collaboration is sort of having like a peer system where if you feel like you're overwhelmed or you need some time off, um, I don't wanna call it job sharing, but we have instances where you can trade off, you know, shifts, things like that. But also, um, our HR and health plan have some amazing resources, whether you wanna see somebody online, um, or see somebody in person or just, uh, see, you know, take some basic video courses and see where, you know, maybe where they can gauge where your stress level is and then make recommendations. We have a very robust within our health plan, um, health coaches, and it used to be, well, you'd have to go to the office or whatever they, but that's all done. That can all be done by a telemedicine now. And I think it's, like Michael said, it's critically important because, you know, this was, we are living through history still right now. We're still in the federal public health emergency. Covid is still out there and in certain countries it's still running rampant. Um, we're living through history here. We don't fully know yet the impact of this, but I, I would say that the, the issue with like provider burnout and stress is at the top of everybody's level now in healthcare, because our healthcare providers are the system. It's not the bricks and mortar, it's not the technology. It, you know, it's not the, uh, equipment at the hospital. It is the providers, the physicians, the physician assistants, the nurse practitioners, the nurses, the dieticians, everybody plays a role. And so I think, you know, what we've tried to do, cause we have a health plan within our, uh, delivery system, we have really worked hard to make sure and constantly repeat that there are resources available. And each one of our clinical departments has folks designated, you know, whether it's the vice chair of a department or division chief, to be cognizant of these issues and try to, instead of, cuz no one, you know, a lot of us, we all wanna say, oh yeah, we're good, I'm fine, I'm fine, I'm fine. But sometimes maybe you're not fine. But being able to confidentially talk to a, a peer, um, get some recommendations and if, if folks need time off, they're gonna get that, there's no question about it. But also for just their wellbeing. If there are things we can do through the health coaches and things like that, let's do it. So it's, uh, it, it, I think, you know, this is gonna be very, very important going forward, um, because, you know, there is an aging population of providers as well on top of this. So you have to think about how to best manage this. You don't wanna hire a new emergency medicine board certified physician, say, well, you gotta work$2,500 a year, they're gonna burn out in three years. And, you know, that'll be that we've gotta manage this, you know, um, a little closer than probably the healthcare system did before. But these issues have brought, these crises have brought the issue to the forefront. And like Michael said, his, his organization is addressed and it we're addressed it, and I'm sure a lot of others are too. And so I think at the end of the day, if we can mitigate a lot of that, it's gonna, it's gonna be a win-win for our patients, for the providers, for everyone.

Speaker 2:

So Terry, one way that before the pandemic, we were looking at physician burnout and also looking at physician satisfaction was related to payment reform and value-based care. The idea that it wasn't, you know, overbooking a physician where they're back to back because there's an assumption that a certain number of patients are gonna cancel, and then they're like back to back to back in an office setting, um, you know, set up to fill before they started their day. Might sound familiar to some of us lawyers too, um, set up to fail before we started our day, um, with the schedule like you, no one could humanly get through that. Um, and the idea that, uh, at least the intention of value-based care was to make the, you know, to have patient centered care, which is a satisfier for physicians, but also to be able to ultimately slow down your practice to spend more time focusing on your patients and also have the right caregiver at the right level, you know, working to the top of your license, um, providing these other like care coordination and other services. Do you, do you see, you know, do you see this, um, coming back? I mean, it seems like I, I'm, I'll tell you, I'm seeing, you know, this is the work I do, I'm seeing, seeing more and more of it, and the thing that I'm seeing that feels different to me is the integration of technology in a way that I feel like I've been advocating for years, but I'm, I'm seeing it now. What, what are you, what are you seeing or what are your thoughts on that? Terry?

Speaker 4:

Another great question, Sarah. Um, yes, we, you know, one of the things, you know, payment reform is a, is a very complex issue, as we all know. Um, but c m s continues to be innovative and they have a lot of new programs where it is more, um, sort of team-based care that's not across the board, and it may never be. However, what we've tried to do at U P M C is, um, within a practice group, whether it includes physicians, physician assistants, nurse practitioners, nurses, other, you know, clinical staff, we have really tried to have everyone be able to work, like you said, sort of at the top of their license, but to be able to, uh, share the medical care and medical decision making. And so that one physician in that group isn't just constantly slammed. You know, when patients come in and they, they have to be the one to see them. Um, you know, our physician assistants and nurse practitioners with their supervisory agreements can do a lot of that work. And so one of the things that's very important I think going forward is, is the integration of the advanced practice providers, like the physician assistants and the nurse practitioners. And the other thing is obviously, and you mentioned it and we all mentioned it, the technology, the telemedicine, uh, you know, I can't tell you how many times I've talked to our providers and said, and they've said, you know, I've actually, I'm seeing more patients, but I'm not as crazy because busy, because I'm able to do part of my day in person part of it. We have scheduled visits set up on, you know, our mobile app and things like that. And so it works well, and they, you know, one of the, one of, uh, one provider told me a specific story that, you know, he had a patient that, you know, they just hated to go to the, the doctor's office and they had some conditions, things like that. But, you know, they're still fairly healthy and everything, but they just dreaded it. They just dreaded going, getting their blood pressure done, getting their testing. And so instead of them having to come in three or four times a year, now they might come in once they do the blood work and, and, you know, whatever's required under, you know, medical necessity. And then they're ab they've been able to do it via telemedicine, the other visits, and it's like, it's a win-win because the patient, you know, he, he suggested the patient's been a lot more forthcoming when they're actually not in person and they feel like they can just say, Hey, you know, this is how I feel today, or this is what my blood pressure was, or this or that. But it also for our providers in our clinical groups, the technology, you know, we're not all quite there yet of exactly how we're gonna use it going forward, but I do believe the buy-in has happened now by our clinicians given covid. And I think that's a good thing and we'll continue to retool and refocus it. But I do think it's gonna be very helpful to, in dealing with some of these issues about like physician burnout.

Speaker 2:

Yeah. And so Michael, um, so what Terry said, when I think about the first, like M S S P A C O proposed rigs, or even when the program launched, they really like left out like skilled nursing facilities, which is where the most vulnerable Medicare population sat. And, you know, they did end up changing that part of the program. Um, there's also something that's a little different, which is, you know, the idea that you, you know, there's some things you can't put on telehealth, but then there's also a way to supplement with telehealth. Um, what are you seeing around, or what are your thoughts around payment reform? Um, especially given now that we're seeing that long-term care and, and actually can be one of the most impactful ways to improve quality and, um, and cost effectiveness,

Speaker 3:

Right? And, and I think, um, the long-term care industry, uh, a as you all know, and as I'm sure many in the audience know, had a, a change in reimbursement, uh, occurred just before the pandemic, right? In terms of, uh, the implementation by C M S F P D P M, um, with respect to, um, one of the ways in which we're we're, you know, Medicare is reimbursed, and so, um, a lot of that change was occurring or had been occurring just prior to the pandemic. And I think that with the pandemic, we've seen, um, much more of a focus on, as Terry was mentioning, really, that, that, um, care coordination, you know, value-based care that is really, um, driven by an interdisciplinary team that I think will be one of the benefits coming out of, um, the pandemic. Because this was an opportunity, um, despite all of the challenges that the pandemic provided, it was an opportunity for at least the long-term care industry to see how effective an interdisciplinary team could be with added support from technology solutions. So C M s implemented waivers around telemed, um, for our industry, um, you know, during the pandemic, they continue to exist. And, um, I, I think this was a good time for our, um, our industry, our organization in particular, to, to see, um, really real world examples of how telemedicine, telehealth, um, technology solutions can really support the, the care that's provided by caregivers. So I, I think there is actually a lot of optimism on our part, um, with respect to going forward in terms of how technology can support care delivery. And on the reimbursement side, I, I think we see those opportunities and some of it is unknown and, uh, you know, there's still a, a large part of it where we need to get back into, um, understanding and observing how P D P M will impact operations. But those are all things that I, I think there's, there is some, uh, at least hopeful optimism, uh, around in, in our business and in the long-term care industry. And I hope you don't mind, Sarah, but I just wanna say to the, one of the points that Terry was making earlier about, um, telemedicine, just anecdotally, and I'm sorry it's about me, but I will just say that during the pandemic I used telemedicine services, actually Terry o be, please note from U P M C, cuz my PCP is with U P M C<laugh>. Um, and, and I have to tell you that I did it because, uh, I think of one of the examples, Terry, I didn't want to go to the, the doctor's office and go through another COVID screening. I had been doing it enough, um, at our office or in our buildings, and I, I thought, I just don't feel like going to have the temperature taken and the mask and all that stuff. So I did it from my home and, and it was great. So, um, I think, you know, it really, technology I think is something that really is, is where we've seen a lot of opportunity and a lot of, um, ease of use and, and hopefully, uh, to Terry's point, you know, it's something that, that really sticks after this. Cuz in long-term care that can be a difficult transition. You know, it's, it's, it's an industry that is not one to, um, often change quickly with the time. So, um, sorry, just wanted to offer that

Speaker 2:

<laugh>. No, I think that's great. What do you have to say about that? Terry

Speaker 4:

<laugh>? I, I was know, I was gonna jump in. You made me the punch there that Michael, that's wonderful. And just, you know, just to hear that and thank you for sharing your experience, um, you know, that that does it, it means, it means so much because, you know, we, as you know, as attorneys and compliance folks, you know, we're there working hard, typing up documents, doing our research, you know, calling our outside counsel like Sarah, like, oh my God, I don't know what to do, I'm about to jump out the window. Um, but just the fact that, you know, you work on these projects and you see them evolve and then all of a sudden, holy heck, it worked like this thing's working, it's HIPAA compliant, the patients are happy, you know, there's been great quality. So it's, it's, it's really in a way just very humbling. But, but I also will just say, you know, on a professional and personal level, um, I have, you know, I, I had no idea I would end up in healthcare, let alone at U P M C, just, you know, even putting aside U M C just to be able to help the folks that help all of us every day and our family members and friends and community. So it's, it's really, it's, and we've all discussed that. It's, it's very gratifying.

Speaker 2:

That is true, Terry. You don't always get to see the positive side of what we've worked on. Sometimes we, you know, people will call us when it doesn't go well,<laugh>, right? So it's always nice. Oh, I nice to hear when it, when it, when it, you hit a home run, you know? Um, so that leads me to wanna ask you both, both this on like a more personal note. Like, um, I played this game with my kids and I made, I made some GCs do this the other day on a podcast, which was, we played this game High lo haha. And the idea is what's the highest moment, what's your lowest moment and what's your funniest moment? And so I'll give you a second to think about it and I'll, I'll try to make up another ones for myself here on the fly. Um, but, uh, it would be nice to hear what, what, from your perspective, what that was. And I'll, I'll tell you, um, my, my highs were, were really like being able to get information out to people that I thought were critical in like surge areas. Like you were talking about Terry, where there was an in-house council who's trying to figure something out and the government page is changing and this is happening. And sometimes it's just needing a sound board. Sometimes it's just needing a perspective. Sometimes it's needing a citation or just the permission to go do what's right, you know? Um, and so I feel like that was my high, um, and my low was sometimes hearing from those same people, um, you know, about, about the people that were, were dying in their facilities and, and how hard it was to watch that and, and how sad that was. So that, that was my low. I think my funny, my most recent funny was I feel like I'm like back in college cuz I caught myself. Um, and I'm sure we're all just really busy and I'm sure everyone's listening who's a health attorney compliance professional, or even in healthcare, it's running around, crazy busy in your own, A lot of us in our houses, some of us in the facilities, but I caught myself in the kitchen, like eating a bowl of cereal, standing up, just like shoveling it in my mouth,<laugh> as my lunch. And I thought, oh my gosh, I reverted back to college. What happened to me,<laugh>, I'm just like, all right, time to go get like one minute to eat some cereal and like, go. And I thought, oh my gosh, I'm so glad I'm not on a Zoom call right now with people watching me. Um, so, uh, Michael, I wanna have you go, can you tell us what your hi was, uh, your during the pandemic or, you know, recently, uh, low and you're a funny moment?

Speaker 3:

Sure. That, that's, um, this is a good question, Sarah. Yeah. So I think, um, the high for me during the pandemic really goes back to, and you mentioned it earlier, um, I think there were many times that this happened that it just gave me such, um, personal satisfaction was really the way in which I saw our team members, our caregivers, our people collaborate with other people, whether inside or outside of our organization, caregivers were working nonstop to make sure that residents were safe and, and cared for. And I constantly heard stories from people about the skilled nursing facility down the street that didn't necessarily have the most up-to-date information, um, from their corporate office. And so our people would call and say, well, can I share this? Can we give this, can we, and and it was just, you know, no questions asked. Like, yes, do it. I, you know, this is great if we can help people. Um, so I think that just, that was one of the great, um, high moments that fortunately reoccurred many times it would sort of get you through those lows, um, during the pandemic. So, and I, I think that just speaks to the way our, our team stepped up to help support those caregivers because it, it, it shows you that everyone was focused on people and keeping people safe and delivering good care to those people, good healthcare quality care to people. I think the low for me was really sort of early in the pandemic and just from, from my seat in the organization and, and, and sort of my view on, on, on all of our sites, um, we could see as, as the pandemic was starting the way in which the virus was progressing. And so, you know, we were good in that we had information available, we shared information, we had clinical playbooks, we had, we were making sure that clinical guidance and guidelines were being shared, um, with our sites. But at the end of the day, sometimes you would go home and just know that despite all of the good work that you did to get information to people, make sure that they had supplies and p p e, um, you know, all of that work that was being done, you still just saw on the map this virus, um, coming. And so that was often, um, frustrating. But, you know, it, it also in a way just gave you the motivation to get up the next day and keep going at it and keep making sure that you had the PPE available and you were getting into the sites and you had the, the newest, the latest information from C D C and other health sources, um, to, to share with the site. So, um, but that, that was one of the low points I think for me. Um, the funny I, I think for me is, is um, it, it, it's a little bit of a tougher one, but I, I feel like just Zoom has sort of, um, taken over my life and I feel like sometimes I'm using Zoom etiquette in now social settings that we can be out and about more freely. And it seems that Zoom is carried over, sort of like you said about reverting to college. I feel like sometimes I inadvertently sort of flip into Zoom mode, um, even out in public now sometimes. So, uh, I wish I had a mute button, um, often in conversations. Um, but uh, it hasn't, hasn't gotten there yet. So, um, yeah, good question though.

Speaker 2:

Thank you. That's funny. My client was just, I was laughing with somebody, um, like again, reemerging into public for, for those of us that were, uh, more at home for longer, and really your interactions on Zoom is, uh, like, it's like, wait eye contact? What's that<laugh>, how do I do that? There's no screen and I need to be looking at at least 20 faces and my eyes need to be shifting everywhere. It's like, when did that happen to me?<laugh>? Um, so Terry, how about you? What was your high, you're low and your funny moment.

Speaker 4:

Yeah, the, it's such a great format, you know, I've been listening to you guys and what great, um, answers and anecdotes and, you know, I I I would just say this as a high, um, right after the pandemic hit in March, uh, you know, and then all of a sudden all these roles folks have to work from home, this and that. I decided I'm gonna work in the office. And I talked to my boss, he said, you know, it's your decision, but most folks are gonna be at home for a while now. And I, my high was like the first like 30 days of Covid as crazy as it was. And I, I felt scared just like everybody else cause I didn't want to get it. I didn't want anybody to get it. But all of a sudden, you know, there's a million questions about telemedicine, can we do this? And people are like, did we ever think of this? And the great thing about it was, I mean, some of the rules Shane, like Michael said, for reimbursement, which has been great and hopefully they'll do that forever, but it was my high was I was able to be available and fairly quickly, I'll say fairly quickly or timely, be able to answer just about all their questions intelligently. I mean, I was getting over a hundred emails a day specific to telemedicine, let alone all the other stuff we do with the health system. And just being able to say, yeah, you need to do this, we've done that, blah, blah, let me check on this. And it was just, it was an exhilarating, it's more than a moment, but I, I look back and there was the three or four weeks I just, and I was just, I'm proud to be able to get through it. And I felt like, you know, as, as attorneys and, and compliance folks here in healthcare, you know, my, my story is if, if you put the time in and do the extra work, it will reap rewards and benefits, whether that's financial or not, or a promotion or not. So be it, but be, to be able to help your clients in a time of desperate need because you've put the time in was, I don't know, just, it felt very good. So that was my high, my low, uh, and I'll just share it, I, I, uh, turned 50 last year on Thanksgiving Day. Um, the Pittsburgh Steelers were supposed to play the, uh, Baltimore Ravens that night in Pittsburgh. And I was born on Thanksgiving and it, and it shows up every periodically, but it's not set. But it was like, for my 50th birthday, four days before that I was diagnosed with Covid. And you know, at that point, you know, things were not stable yet with Covid, but I had to stay home and quarantine and I didn't get anybody infected. But it was a, it was a low point cuz I just felt like, geez, all this stuff we're doing and everything, and now I got it and somebody else is gonna get it. I had a fairly mild case, but I still had the, you know, quarantine like the physician my doctor said. But it was a low moment where I just, and I, I was able to still do a lot of of work. I was tired, but I just felt like, geez, I mean this thing is, you know, we gotta get this done. I mean, you know, we gotta get back to the normal life. And so it was very difficult, but I feel very fortunate and made it through. Okay. My, my, my haha is, um, I know Sarah knows this, I'm a big music fan. I love the Grateful Dead and Pink Floyd and, and other bands like The Doors. But being at home as much as a lot of us have, I have a million, not a million, but hundreds of box sets, the Grateful Dead of Released like 800 concerts. I collect them all and I've been finally able to listen to them. But more importantly, like open these boxes up, they have nice books and pictures and memorabilia and, you know, dark side of the Moon if you buy the vinyl and has these two posters, the original posters and stickers and like a lot of this stuff you look at once and never look at again. And so I, I did feel like I was back in college all of a sudden. So

Speaker 2:

That's incredible. No, I love that. That's great. Um, I know it's, it's uh, you know, that's a, I mean both of your, the stories of the haha stories are, they're, they're a little bit about, um, a little bit about resilience and a little humor and, and trying to, you know, I think as a lawyers, we, our tendency is when we see caregivers struggling is to, if you're a good health lawyer, is to want to help and work through those issues and be supportive. Um, at the same time we don't always give our poor self, we give, uh, we might, we give doctors permission and say, you know, you're human, it's okay. And we sometimes have a harder time doing that with our ourselves as attorneys. Cuz I think we have similar training in which we are taught to keep working and going. And so hoping out of this pandemic that's something that, um, will resonate both with, with a lot of people, not just lawyers and caregivers and, and doctors. So, um, with that, um, I'm gonna ask you both to give a takeaway that you'd like to leave the audience with. And I'm gonna start with you Terry.

Speaker 4:

Sure. Um, and thank you Michael and Sarah and everyone listening today. This has been really, uh, it's a real privilege and honor. You know, my takeaway and you mentioned the word resilience is a resilience and my takeaway is especially if, if you haven't been practicing that long, or maybe you've been practicing a long time and you know it's long hours, it's stressful, you want to, your work product needs to be great and everything, but my whole thing is, my takeaway is this, do your very best sleep well at night, be confident, but most importantly, enjoy what you do. Find things within your job and in your career. Whether that's con conversing with peers, whether that's saying, Hey, I really like telemedicine, I wanna learn all about it. Um, do things that for yourself that will make your work and your your client relations even better. And, you know, the sky is the limit. We have interns that have come through and I tell'em the stories from when I started to where I'm at now in my career. And I'll tell you those first couple years at U P M C, it was very difficult, but I got thrown into telemedicine and there's no going back for me. Um, that's it. But Sarah knows that, but thank you.

Speaker 2:

Yeah, thanks Terry. Um, Michael, what would you like to leave the audience with?

Speaker 3:

I think, uh, Terry definitely just gave us some great advice and it has certainly been, um, a great opportunity for us to, to talk here today. Thank you Terry. Uh, been great to, to get to speak with you, Sarah. Thanks so much for, for coordinating this of course, with h l a, um, I think for me, really what the takeaway is from the pandemic, when I sometimes think about everything that, um, happened and everything that people went through, our, our caregivers, our residents families, it's just been a good reminder and particularly for the work that we do as health lawyers, it's been a good reminder to find those opportunities to stay positive, have your haha moment. Um, I think that was such a great question, Sarah, because it, it really is important to find those times to just lighten the mood and, and bring a little bit of levity to your day and share that with a colleague. I think that's been, um, one of the things that, that I've tried to focus on and, and really I hope that others take away because we deal with so many serious issues, frankly, even outside of a global pandemic, we deal with serious issues because it's healthcare. And so really just finding time to, to be positive, to laugh. I, I think laughter is something, um, at least in my family that has just always been, um, such a great stress reliever for me and, and something that, that, you know, really I think is something that's a good takeaway for all of us to find those moments, uh, in our professional day to really lighten the mood. And I think it helps you reset and do a better job, uh, as a, as a health lawyer anyway. So thank you.

Speaker 2:

Thank you, Michael. Thank you Terry, for joining us. I wanna thank the audience for joining us too. Um, and I also wanna just do a shout out to a H L A again because, um, so many of the connections and people that I had as my support network or who I was, their support network, I have met through A H L A. So, uh, keep tuning into these podcasts and, uh, and thank you A H L A too. All right, bye everyone.

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.