Legal Challenges and Healthcare with Sarah Swank

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to a Virtual View, a telehealth podcast, brought to you by the Upper

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Midwest Telehealth Resource Center.

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Today I'm joined by Sarah Swank, health attorney of

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Nixon Peabody in Washington DC.

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Sarah, thanks for taking the time to join us today.

Sarah: 00:00:22

Yeah.

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Thank you for having me today.

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Yeah, and this isn't your first podcast, is it?

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It isn't I guess I didn't mean to be the podcast queen, but

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just like you, I've somehow am out speaking more and more on.

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Thank you for adding ours to your list.

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Could you introduce yourself to our audience?

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A.

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Yeah.

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So I am Sarah Swank.

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I'm a healthcare attorney.

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I've been a healthcare attorney for 23 something years in there.

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And I have I would say I'm of a traditional healthcare attorney in that

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I do regulatory and corporate work, but I would say I'm not a traditional

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healthcare attorney because I am driven.

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A lot by what I think are innovations, changes and improvements in healthcare.

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And not that I think I'm the only one, I think a lot of people are but

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when we talk about where my interests lie and where I go you'll see that

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the clients and the people that I'm working with are really trying to push

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where healthcare delivery is going.

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So I have to admit, looking at health and healthcare from a

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more legal perspective that's not something that I've really done before.

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It's not my first thought when I think of healthcare, so what does

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being a health attorney entail?

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Yeah.

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So for a health attorney it's funny cuz it's one of those things, like what

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attorneys do is you're, let's say you're at an event and someone asks you what

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you do and you say, I'm in healthcare.

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And then you say what do you do?

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And then you say, Are you a nurse?

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No.

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Are you doctor?

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No.

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Are you a pharmacist?

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No.

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And then you say, I'm an attorney.

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And they say, Oh, are you a malpractice lawyer?

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And they're like, No, , I'm not that either.

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So what do we do?

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There's a lot of regulations.

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If this was easy.

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You wouldn't need me.

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And honestly and with every like advice you give, there could be thousands

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of pages of like regulations and law and that sit behind, behind that.

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And, but what I think, so there's that part of it.

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Healthcares are healthcare is has corporations, a lot of it, some of

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it's public, but a lot of it's private.

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And so we have those regulations overlapping with a private

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industry in our country.

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And then we.

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Federal dollars that come in.

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And so we've got Medicare and Medicaid laws.

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We are United States, we've got, in these federal laws, but we also have state laws.

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So it's it gets complicated really fast.

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But I think what I think what do I do?

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I try to help.

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Understand what people's visions are.

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Try to navigate all that's going on.

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Maybe sometimes even get out ahead of it with health policy and try to make

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sure that care's being delivered in the United States in the way it should.

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And, for clients, what I'm I say is, I'm, I, my favorite things

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to do are to build things, right?

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Like I love sitting and helping to build.

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But the other thing I do with like compliance and otherwise is to help

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people do the right thing, right?

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Like to complying with the laws is the right thing to do right?

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And if there's times where it's in the gray, which happens a lot,

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especially in telehealth, right?

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As it's changing so fast, is to figure out, what can we mitigate?

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Where's the risk on this?

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What does the program look like?

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What are the details that make it go into compliance?

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Cause it's, if you're on the cutting edge of healthcare, If you're not

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trying to go out and break the laws, but there's some of the laws might have not

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caught up where you're trying to head.

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And so that, those are my favorite projects to work on are with people

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that are really, have a passion and a drive towards changing healthcare and

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healthcare delivery, especially using technology and people in a innovative way.

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And then helping them navigate it.

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And those are my favorite.

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So that's what healthy is.

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I think a really good health care lawyer also becomes an advisor, has

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business knowledge and ment hopefully, and seen enough deals, seen enough

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of this or that to say, Hey, by the way do you wanna do it that way?

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Like you could.

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And I think those are also some of my favorite moments when we're

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having these really great strategy talk talks and trying to figure

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out, how do we do things best or.

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Very cool.

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So you talked that you're involved with telehealth.

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How's that something you became interested in?

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Was that deliberate?

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S

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Yeah, it's so interesting.

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So I tripped into health law.

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I didn't know what kind of attorney I wanted to be.

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There's a lot of us that came out that timeframe.

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There wasn't as many laws back then to even comply with.

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So you tripped into the health law and then, I was, government

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and psych major, if anyone out there is fascinated by my majors.

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But I was obviously drawn towards healthcare in that I was thinking

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I'd be a clinician myself, right?

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Like I was thinking about going and becoming a psychologist and and just

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left that behind and thought I'd be an attorney and then here, Health law.

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So where did Telehealth come into it?

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I think some of my first projects where I was drawn and I was interested in

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them was watching some of the first technology go into like manage care in

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New York and watching the change of people trying to get data out of these really

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archaic systems and things, really being on paper and trying to figure out how

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do we care better for these patients?

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And I.

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Gravitated to that.

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And then I think my first real exposure to telehealth as we think of it today

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was I was in house at a hospital that was really trying to figure out how do

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we get like a specialist to see a patient or something when there's like a lot of

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traffic in dc for example Or it could be the office in the rural IT community.

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It could be, how do I.

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Do I drive two and a half hours?

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Like it could be two and a half hours in traffic or no traffic.

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It's still difficult if you have to try to get to somebody and how do we solve that?

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Or if you have a very specialized, like in the hospital visit, like

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with a pediatrician, how do we get the doctor across the traffic?

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Maybe that's not gonna make sense or the big long distance to get to the patient.

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And so that's how I got involved.

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And I just joked that things were rolling down hallways like . It

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was not the same as it is now.

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And really what I would say is, I've always this, but it's

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the technology that's changed.

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And now we can say the laws have changed, the reimbursement's changed.

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But the concept hasn't.

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And that's how I got involved and then why I stayed passionate in it and

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really gravitated again to trying to work with people that are trying to do

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this was because personally I saw it as so many opportunities in it, even

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when there was no money in it, right?

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Like some point there wasn't a lot of payment in it, and people were trying

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to figure out, do I go to employers?

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Do I just do this because it's actually keeping costs down and

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admissions outta hospitals down.

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Like, why am I doing it?

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I still thought, Gosh, look at the benefit of this.

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And I even remember going to the American telemedicine association and

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it was one of the first speakers that said, I'm seeing all the, there's

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lots of legal barriers, right?

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That was a lot of the things you're talking about, telehealth.

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And I said, But look at what's happening with the Affordable

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Care Act ACOs population.

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And yet at the same time, isn't that like telehealth that kinda helps

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with some of this work And just came out and said, I don't think you

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should be scared of the laws as much.

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Don't use that as an excuse, right?

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Like it's an opportunity and a barrier, but let's see what we can do.

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And so that, that's where, how I got involved and why I've stayed involved.

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Now it's so exciting.

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I don't even, there's so much going on in this space.

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So we talked a little bit about the fact that there's legal challenges

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associated with telehealth specifically.

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What are some of those specific legal challenges?

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I think the first, I think I, I said this, but I really hit it home.

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The first one was there was no reimbursement for a lot of this,

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so it's like, where do you get funded for or why are you doing it?

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Where and not to say that the money drive is, drives everything, but at some

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point you have to say, it, it's a cost.

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And honestly, if not enough people are doing it, it's hard to get the

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data to show it's effective even.

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I think the other barrier that you hear a lot is around licensure, right?

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Like the idea of if I wanna do this in 50 states, which we get this a

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lot, like in my firm at Nixon, like I wanna do this in 50 states, but

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I can't be like, how are we gonna, what's the licensing strategy or what?

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And that got even more wild during.

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Covid in the pandemic in the public health emergency cuz all the states

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were doing different licensing.

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They were changing their licensing as we were going.

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And even if you're not saying I wanna do 50 states, your patients

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may be in a tri-state area cuz you're on the edge of a state somewhere.

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Your patients might have decided that they wanted to go visit a family

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during this public health emergency.

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Maybe they needed to go stay with family, or maybe they said, Hey, I

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just wanna go on vacation for two weeks and just go to somewhere warm.

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I, you don't know.

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And so there you are, like, and are you properly licensed to talk to that

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person as they're moving, or honestly, Again, we'll go back to not just

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the patient's, move, the people, the providers move, the physicians that

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now it's even bigger social work.

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Tell us psychiatry.

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They can move too.

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They might decide they wanna take a two week vacation and half of

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that will work remotely out of.

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You all their visiting family in a confidential space.

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And can they do that?

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Are they licensed to do that?

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And licensure becomes a huge, can become a huge barrier.

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We figured out how to do it.

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It's a lot of work.

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There's a lot of people that say, Why don't we have a compact on

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this, like the nursing compact or some like national standards.

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But we're not there yet.

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I We've been saying that for 10 years.

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. Those were like the two biggest ones that you hear a lot.

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There's other ones too, because we've got now, which is really

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exciting, like the opportunity to have other people besides physicians.

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It used to be telemedicine that meant doctors.

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It's not.

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It's all kinds of clinicians, which is really great.

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They all have their own scope of their license and what they can and can't do.

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And so now we have to think about and who can supervise them, Who

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needs to be watching their work, who needs to be overseeing them?

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And each of those are state by state.

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So you may be able to have a nurse do something here or a, like an LPN or some.

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other category and you have to go, Huh, the right people.

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Could they say that?

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Or do they need to be scripted?

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Are they a health coach?

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Are they a nurse?

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Are they a doctor?

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And so even that concept of telehealth is so exciting, but a big legal

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barrier where we're really having to think through things are, corporate

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practice of medicine, scope of license.

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And scope of supervision requirements within the state.

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And some again, though, some of those got waved during the pandemic, but

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those waivers are coming in and out and some of those things have stuck.

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Some things are not gonna change.

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I A lot of these laws were set up like in a traditional brick and mortar sense.

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They weren't set up for telehealth necessarily.

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Yeah.

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So an emerging field in telehealth and really technology in general is

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artificial intelligence, and I understand, is that an area of interest for you?

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It is.

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Absolutely.

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Yeah.

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I would assume that AI is something that, for a whole host

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of reasons, might come with some very interesting legal questions.

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Yeah.

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AI's very interesting because.

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There's not a lot of regulation around it if you look at it from a national

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level and that or even a global level.

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And we're seeing the regulations of it in other countries, like in Europe.

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But what I think is interesting about it is, artificial intelligence

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is not that regulated, and yet we're looking at if you look at.

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We say about where we need to be with it as a country, like as our like economics

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of our country, which includes healthcare as one of those economic factors.

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It's a priority.

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So it's and obviously healthcare's something that's a huge part of

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our budget in the United States.

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It's a huge part of our economy.

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And so it naturally makes sense that like we're gonna wanna promote some

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level of artificial intelligence.

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And so that's, it's interesting, some people say how did you get

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involved in artificial intelligence?

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It's not like I knew 10 years ago that I was gonna be thinking about

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artificial intelligence necessarily.

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Or maybe I could have predicted some of it.

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There's some of it that's in there.

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But what I think is interesting, it's the natural flow of the use

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of data and technology to care for patients or to transform processes

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in healthcare just as it could infor, it could transform processes in any

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industry or even our daily lives.

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A good example of this is, Bots.

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So bots, a lot of people say bots aren't artificial intelligence.

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But if we're gonna use this broadest definition, cuz the definition is all

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over the place of how we think about it.

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If you said, When I get healthcare, a little text message is gonna show up

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and then it's gonna talk to me and then I'm gonna go do something, we would

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all say, Gosh, that's like inhumane.

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I might not feel cared about.

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I'm gonna like it.

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Now go look at covid testing.

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And how we got bots.

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I said, Do you have this system?

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Do you have that da?

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And then it directed you to something to do.

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Maybe it was a telehealth visit, maybe it was to go to your doctor,

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maybe it was to go to testing.

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And we were not offended by that.

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So we can see how when that starts getting integrated into care delivery or

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even the backend processes in EHRs and getting realtime data out there's some

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real opportunities there, but legally, We have to look at the laws that kind

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of, that exist now and frame this new technology over it, which sounds a lot

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like the, like telehealth or telemedicine.

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A long time ago, a lot of laws weren't out there, and so we have to take

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this technology and say, what is the framework and how does that framework

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of our laws, is it working or not working based on this technology?

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I think where artificial intelligence a little bit different than telehealth is.

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It's got such widespread use outside of even healthcare, like that, that it's

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not just a healthcare, thing, it is something that would be transformative

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to a lot of different parts of our lives.

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Yeah, it's the next big horizon in technology.

Danielle: 00:13:05

But you talked about bots and stuff, and I was reminded, like two days ago, I got

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a message from my dentist reminding me to come in with one of those like AI systems.

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And then I got one from my GP as well, and I'm like, Wow.

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Five or 10 years ago, I wouldn't even have thought that this was possible, but

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it's just become so commonplace recently that we don't even think twice about it.

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But something else you mentioned that I wanted to talk about was, you mentioned

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how healthcare is a huge part of the sort of market or the economic landscape of

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the United States, and I think that's very true because it's one of those things that

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you, , you really can't get away from.

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Everybody engages in.

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Health to some extent during their life, obviously.

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So I know this is a very broad question, but with the development of other new

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technologies, even aside from ai do you think there are any legal or ethical

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issues that might stand out to you as things we're going to need to confront

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as we continue to have this huge development of new health technologies?

Danielle: 00:14:07

Is.

Sarah: 00:14:08

I think for me, what, and I'll use artificial intelligence as a place

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to think about this cuz it could.

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It could be a lot of places but really what is, when I first started going out

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and talking about artificial intelligence as an attorney, there weren't a lot of

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lawyers out there talking about it because there wasn't a lot of laws out there.

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And so you're trying to talk about navigating certain laws, but what I, one

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of the things I would hit home is the ethics behind it, the morals behind it.

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And when you look at the ethics and morals of artificial

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intelligence, you're looking at data.

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And even if.

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Whether it's data that's a pixel and how many pixels there are to be able to look

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at, a breast cancer scan to see whether it's breast cancer and the computer's

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looking at it and or whether they're like looking at o other processes.

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You're taking data out of our healthcare system and even, know, if you look

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at the, there's a NIST report and I S N I S T, but people in telehealth

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probably already know who they are but They, they said we think there's bias.

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Where does this bias come from?

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They come from healthcare's part of our society.

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It's part of systems and who comes and access healthcare.

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That's the data that's in the system.

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How we track it is how it's in the system, how we ask about it.

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It's in the system.

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And having talked to data scientists who think about the word way

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differently than I do as an attorney say, there's information in there.

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We could be doing all these great things.

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Of course we have laws and things that say maybe you can, maybe you can't.

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We also have the way our system's structured, which is system by system.

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It's not like a big national system where all this data's

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getting pulled into it, right?

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So we've got that and then we've got again, like our biases.

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And a really good example of that is if we look at clinical research,

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clinical research, Is done.

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It gives us evidence-based medicine.

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It proves our drugs and devices.

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It's like a process we get through.

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And at the end of it, we've got, some product that can be used under the market.

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It could be a drug or it could be, a new way to care for

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patients, whatever that research.

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But if you don't have people of different diverse backgrounds, in every way

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of that underserved communities in every way we can think about that.

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Do we really know if that science is correct?

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And so I would say, artificial intelligence, you could say,

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Okay, we've seen it really work well in clinical research.

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Where did it work?

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There it can be helpful in being able to identify patients that

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might meet a criteria for a study.

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It might be really good at screening only for those patients

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that are actually in ther.

Sarah: 00:16:30

If you are somebody who did not want to go.

Sarah: 00:16:33

To the emergency room or go to a doctor because of the systematic biases that

Sarah: 00:16:38

may exist in our world, then you're not in there . Or if you're in a

Sarah: 00:16:41

location, maybe it's a rural location, maybe it's an underserved community.

Sarah: 00:16:46

In an urban location.

Sarah: 00:16:48

Maybe you don't even get clinical research near you and so you're

Sarah: 00:16:51

not in the system to be looked at.

Sarah: 00:16:54

Then we have, so then that data is in naturally inherently biased

Sarah: 00:16:58

towards the, what's in there and the research can, could be then biased.

Sarah: 00:17:02

And there's re researchers that are trying to think about this.

Sarah: 00:17:05

The FDA has put out for the last year saying, you need to

Sarah: 00:17:09

have equity in your clinical.

Sarah: 00:17:12

can throw all the AI you want over it and it won't necessarily fix that problem.

Sarah: 00:17:17

But there, I do think there's hope in ai.

Sarah: 00:17:19

If we understand that when AI gets built, we can build it with bias, that

Sarah: 00:17:24

we can understand the systems and try to figure out if we can break the bias.

Sarah: 00:17:29

And build that in.

Sarah: 00:17:31

But if we now take this moment and build the AI based off of, the people that

Sarah: 00:17:35

are gonna end up coding it, the people that are putting the input in the data

Sarah: 00:17:40

that we have, we may actually bake our biases into the future generations.

Sarah: 00:17:44

And that's the part that I think is the biggest barrier.

Sarah: 00:17:47

And that's, that goes beyond legal, that goes beyond ethics.

Sarah: 00:17:50

That goes beyond what, where do we want, What do we want our

Sarah: 00:17:52

country to look like in the future?

Sarah: 00:17:54

And what do we want healthcare to.

Danielle: 00:17:55

I think that's such an important point because I feel like

Danielle: 00:17:57

a lot of people do look down at data and be like it's just data.

Danielle: 00:18:00

And don't take into account that there are like biases.

Danielle: 00:18:03

And what have you like involved in putting that data together?

Danielle: 00:18:07

One of the things that I do find most exciting about telehealth, aside from the

Danielle: 00:18:12

fact that , I can go to the doctor in my pajamas is the potential utility in the

Danielle: 00:18:17

field of health equity, like you said.

Danielle: 00:18:19

So I know you have an interest in health equity as well.

Danielle: 00:18:23

Do you think that Telehealth can have a role in promoting future health?

Sarah: 00:18:28

I think it does because you, if it can provide more access, right?

Sarah: 00:18:34

In that way, like when we look at health equity and even just defining what

Sarah: 00:18:38

health equity means, we're looking at.

Sarah: 00:18:40

What we underserved community.

Sarah: 00:18:42

So if you look at CMSs health Equity plan, you'll see a lot of the laws around

Sarah: 00:18:47

access are in there and they still sit on the books, but clearly they haven't

Sarah: 00:18:51

completely eliminated some of the issues.

Sarah: 00:18:54

Just cuz those laws are sitting there.

Sarah: 00:18:56

So it's, it is a reframing of that.

Sarah: 00:18:59

And when we, and defining what underserved.

Sarah: 00:19:02

Helps too.

Sarah: 00:19:03

So it's, it is, it can be race, it can be gender, it could be rural, it could

Sarah: 00:19:09

be, it can be a lot of different areas.

Sarah: 00:19:12

And it's, what's interesting is is there a solution that can solve that?

Sarah: 00:19:17

Fact that those are all underserved communities.

Sarah: 00:19:19

I Telehealth could be one of those that serves just to, to cut across

Sarah: 00:19:23

what we are defining as underserved communities, which may have some

Sarah: 00:19:26

things in common and may not.

Sarah: 00:19:28

So like here, but where a barrier would sit and where

Sarah: 00:19:31

the health equity also sits is.

Sarah: 00:19:33

We don't always have digital health equity, so we say yes, it's gonna help

Sarah: 00:19:36

us, but if we don't have digital health equity in that, we mean that we have

Sarah: 00:19:40

these really cool, fancy things we're doing like telehealth or fem tech where

Sarah: 00:19:44

you've got like a phone and you can have a device and you can track thing.

Sarah: 00:19:48

There's all these really cool innovations happening.

Sarah: 00:19:51

But if they.

Sarah: 00:19:52

If you don't have access to them, we're actually creating

Sarah: 00:19:55

what they call a digital divide.

Sarah: 00:19:57

We're actually making it worse for everybody or some people.

Sarah: 00:19:59

And so we look at broadband, right?

Sarah: 00:20:01

There was a, this administration's putting out grants for states to look at, like

Sarah: 00:20:05

what they call the internet for all.

Sarah: 00:20:06

And they have specifically called out healthcare as one of those areas.

Sarah: 00:20:09

And education is surprisingly not another one in the,

Sarah: 00:20:12

economics just general economics.

Sarah: 00:20:14

So that's really important.

Sarah: 00:20:16

If you can't actually get to it.

Sarah: 00:20:18

Like you, you don't actually have access to it.

Sarah: 00:20:21

If you are somebody who has a hard time using the technology, then you don't

Sarah: 00:20:28

have meaningful access and I think.

Sarah: 00:20:31

We saw that with signing up for vaccines.

Sarah: 00:20:33

There's just some people that like, and this wasn't even telehealth.

Sarah: 00:20:36

Were like, I can't use this system.

Sarah: 00:20:38

I will tell you, I had a hard time using this.

Sarah: 00:20:40

It was not always user friendly, no offense.

Sarah: 00:20:42

I know people had to throw them up quickly, but it wasn't use.

Sarah: 00:20:44

So some people just called, I'm just gonna make fun a phone call, because

Sarah: 00:20:48

I, every time I tried to do something, someone else has taken my appointment

Sarah: 00:20:51

and I, I'm having a hard time doing this.

Sarah: 00:20:53

So it's digital health equity isn't just, It is BroadB.

Sarah: 00:20:57

it's digital literacy.

Sarah: 00:20:58

It's and it's also like cultural competency.

Sarah: 00:21:02

Am I somebody who would want to use it or not?

Sarah: 00:21:04

Just say it's absolutely a good thing for everybody.

Sarah: 00:21:06

It might be like yeah, it's a good thing, but we need to be culturally

Sarah: 00:21:09

competent to know certain people are going to wanna access it in

Sarah: 00:21:12

this situation versus another.

Sarah: 00:21:13

And we can't just assume with our biases that whatever we wanna do to

Sarah: 00:21:16

access it is gonna be the right answer.

Sarah: 00:21:19

So there.

Sarah: 00:21:20

There's a lot of equity that comes into this, but there's so much opportunity too.

Sarah: 00:21:23

We shouldn't just say not everyone can have it, so we're not gonna do it.

Sarah: 00:21:25

No, I think it's the opposite.

Sarah: 00:21:27

Like how do we knock down the barriers that are around the access to it so that

Sarah: 00:21:31

we can get those other, Because it like, it's not just healthcare too, right?

Sarah: 00:21:35

If it's an internet thing, it literally might be school, it literally might

Sarah: 00:21:38

be able to start a business, or do you know, And that's not right.

Sarah: 00:21:42

Yeah, I think there's just a, there's a ton of opportunity in it and just

Sarah: 00:21:45

so people know, like, why does a lawyer care about health equity?

Sarah: 00:21:48

I care personally.

Sarah: 00:21:49

But Right.

Sarah: 00:21:49

That's a passion of mine.

Sarah: 00:21:50

But legally, we're watching this, It's gonna get baked into how we get paid.

Sarah: 00:21:55

It's gonna get baked into quality measures that we don't have right now.

Sarah: 00:21:59

It's gonna get baked into transparency laws and things that go on to like

Sarah: 00:22:04

Ford facing websites about this is how much you cost, this is your quality,

Sarah: 00:22:10

and and if your quality scores include health equity scores and access score.

Sarah: 00:22:16

It's gonna be apparent to everybody.

Sarah: 00:22:18

So I, I think, and then honestly like access laws still are out there and

Sarah: 00:22:23

whether they're used or not used, there's a lot of potential for enforcement

Sarah: 00:22:26

around some of the things they're already sitting on the books, nevermind

Sarah: 00:22:28

them getting picked back up and looked at in a digital way, not just look at

Sarah: 00:22:33

it like, Oh, I walk into a building and I can't get into the building.

Sarah: 00:22:37

That's not good, but how about I can't walk into my platform and I can't see.

Sarah: 00:22:42

So how am I supposed to navigate my telehealth visit when I can't?

Sarah: 00:22:46

I can't see it.

Sarah: 00:22:47

And that's just as much of a buried access.

Sarah: 00:22:50

And so looking at these A platforms access and saying, Can I really do this?

Sarah: 00:22:56

Do an access audit on it in the way.

Sarah: 00:22:58

Now if you really think you have problems, do it with lawyer, but do it, go look

Sarah: 00:23:01

at it, say, do I really, Am I really.

Sarah: 00:23:04

These requirements, Yes, it could be the right thing to do, but honestly

Sarah: 00:23:07

you could you will need to do it.

Danielle: 00:23:09

Yeah, but I really like the point.

Danielle: 00:23:12

Telehealth is not the way we fix health equity.

Danielle: 00:23:14

It is one tool and a lot of different tools we're going to

Danielle: 00:23:18

have to use to improve that.

Danielle: 00:23:20

Because I have read studies about the utilization rates of telehealth,

Danielle: 00:23:24

particularly during the pandemic, and I was very surprised at how much they.

Danielle: 00:23:29

It's compared to just rates of traditional healthcare utilization

Danielle: 00:23:33

and how close they were.

Danielle: 00:23:34

I expected folks in rural populations or other disadvantaged populations

Danielle: 00:23:39

to be taking more advantage of it.

Danielle: 00:23:40

But a lot of times, like you said, the tools just aren't there.

Sarah: 00:23:44

It's I think you're absolutely right.

Sarah: 00:23:46

It's like it.

Sarah: 00:23:47

We have big, we have issues that are bigger than this.

Sarah: 00:23:50

Like someone was getting interviewed for an article around modern healthcare,

Sarah: 00:23:54

around like behavioral health and telehealth and hospitals vetting

Sarah: 00:23:59

behavioral health startups, right?

Sarah: 00:24:00

Cause there's a lot of people going into the market and, at

Sarah: 00:24:03

the end I just, I couldn't leave it there, but all I could think.

Sarah: 00:24:07

You need to vet 'em.

Sarah: 00:24:08

You need to like, we need to have more behavioral health access in

Sarah: 00:24:11

every way, addiction, mental health.

Sarah: 00:24:14

But at the end of the day, one hospital system's not gonna solve this problem.

Sarah: 00:24:19

Even 20 hospital systems, even 20 startups.

Sarah: 00:24:22

This is so big of a issue around access and care that we need

Sarah: 00:24:28

to think about it as a country.

Sarah: 00:24:29

We can think about it at a state level too.

Sarah: 00:24:30

I'm not saying you can't like, focus on a state, like a governor

Sarah: 00:24:33

could say this isn't a state emergency and we need to look at it.

Sarah: 00:24:37

That too.

Sarah: 00:24:38

But it's just the idea that we're gonna one off it and that's

Sarah: 00:24:40

gonna solve the behavioral health problem by using telehealth.

Sarah: 00:24:45

or we shouldn't trust the people in the behavioral health

Sarah: 00:24:48

industry going into health.

Sarah: 00:24:49

I don't think either of those are true.

Sarah: 00:24:51

I think that you need to vet it and do due diligence, but I also think it's gonna

Sarah: 00:24:54

solve the entire problem of it because we are looking at the continuum of care and

Sarah: 00:24:58

yeah, you can try to solve some things for people to be at home, but sometimes you

Sarah: 00:25:01

actually do need to go into a facility.

Sarah: 00:25:03

Sometimes you need to, cuz that is actually.

Sarah: 00:25:06

Heal you better, like both mentally, physically, in whatever way.

Sarah: 00:25:10

And I don't think we've figured out that quite right.

Sarah: 00:25:13

What's that ratio?

Sarah: 00:25:14

What does that look like?

Sarah: 00:25:15

And what does that look like for each specialty or each care

Sarah: 00:25:19

setting or each care protocol.

Sarah: 00:25:23

And so I think you're right.

Sarah: 00:25:24

I think people needed their healthcare.

Sarah: 00:25:26

There was definitely delay care.

Sarah: 00:25:27

I People.

Sarah: 00:25:28

Using telehealth right now to patch that d delay care because they can't

Sarah: 00:25:33

get everyone back into the office.

Sarah: 00:25:35

They really literally can't.

Sarah: 00:25:36

But people are trying.

Sarah: 00:25:37

So I think the utilization might have looked the same, but we know that

Sarah: 00:25:41

there's delayed care, especially when we look at like screenings and other

Sarah: 00:25:45

testing and our wellness visits and so yeah, I think it's quite interesting.

Sarah: 00:25:49

Yeah, I don't think it's just it's not gonna.

Sarah: 00:25:51

Our healthcare problems, but it is a tool and our toolkit to, to

Sarah: 00:25:56

start working on it because we do have, we've got a lot of work to do.

Sarah: 00:26:00

And then I guess unfortunately, or fortunately, the pandemic put a lot

Sarah: 00:26:03

of things to light that was really good about our healthcare system, like

Sarah: 00:26:06

science, innovation and use of technology and our actual healthcare workforce

Sarah: 00:26:11

out there and doing amazing things.

Sarah: 00:26:14

but it also gave delight.

Sarah: 00:26:15

Like the systematic biases we have the problems the people falling

Sarah: 00:26:18

out of, how easy it's to fall out of our system and get lost.

Sarah: 00:26:22

So I, but telehealth, I don't think, I don't think we should lose sight of it.

Sarah: 00:26:27

If we are gonna have gone through something really not great as a country,

Sarah: 00:26:30

let's figure out what we learned from it and what we found out was great.

Sarah: 00:26:33

And if Telehealth is there I hope, I don't think we'll lose

Sarah: 00:26:36

sight of it but I hope we.

Danielle: 00:26:38

Yeah.

Danielle: 00:26:38

I do think it is important to keep it in perspective, like you said, where

Danielle: 00:26:42

we're not saying that telehealth.

Danielle: 00:26:44

The entire solution, like it feels a lot like someone's telling you to

Danielle: 00:26:48

build a house and then giving you telehealth and it's like a screwdriver.

Danielle: 00:26:52

It's I need other tools too.

Danielle: 00:26:54

This is an important one, but it can't be the only one.

Sarah: 00:26:56

Yeah.

Sarah: 00:26:57

Yeah, I think it's, it's interesting because even looking through this,

Sarah: 00:27:00

Tell of that is certainly we had the, these different definitions,

Sarah: 00:27:03

like I'm a lawyer, we love words, or at least I do, and definitions.

Sarah: 00:27:06

And so we look at like the evolving definition and I love language,

Sarah: 00:27:10

so our language has to evolve too.

Sarah: 00:27:12

Like the word health is a new.

Sarah: 00:27:15

Health justice and it in some ways it empowers some people and it puts off

Sarah: 00:27:19

other people, which is very interesting.

Sarah: 00:27:21

But when you tell them like, What does that mean?

Sarah: 00:27:24

I've never had somebody say, Gosh, that doesn't seem right.

Sarah: 00:27:27

We shouldn't, you're right.

Sarah: 00:27:28

Why wouldn't somebody have access to telehealth?

Sarah: 00:27:30

Or if I say to somebody, Gosh, there's times you just, you

Sarah: 00:27:34

actually need to be in a hospital.

Sarah: 00:27:36

Or you need to be in a setting like, like in a surgery center or I, When

Sarah: 00:27:40

you explain it like that, people will go, Oh, yeah, that makes sense.

Sarah: 00:27:42

So some of this is we have this great wording and we have these great words

Sarah: 00:27:45

that are changing in it, even telehealth.

Sarah: 00:27:48

But sometimes that we just.

Sarah: 00:27:49

Get away from these academic words and just talk about what it really is.

Sarah: 00:27:52

Cuz it's is a day to day thing in our lives.

Sarah: 00:27:55

We have to, either we or somebody, we in our lives is usually engaging in some kind

Sarah: 00:28:00

of healthcare interaction at some point.

Sarah: 00:28:03

It's not, and.

Sarah: 00:28:04

And we like sometimes in healthcare, overcomplicate it with all our terminology

Sarah: 00:28:08

and including telehealth or bots or ai.

Sarah: 00:28:10

What does that really mean?

Sarah: 00:28:11

So maybe even telehealth will get involved cuz we got virtual visits now and this

Sarah: 00:28:16

and it's just all these different phrases.

Sarah: 00:28:17

But the idea is you don't get lost in the shovel and you don't get sick without

Sarah: 00:28:21

somebody knowing about it, hopefully.

Sarah: 00:28:24

And that you're, hopefully you're getting care and hopefully you're

Sarah: 00:28:26

not using the emergency room as your.

Sarah: 00:28:29

Care source, that you're getting the right place.

Sarah: 00:28:31

Yeah, I agree with that.

Sarah: 00:28:32

I really do.

. Danielle: 00:28:33

I know we touched on a lot of this already, but one question

. Danielle: 00:28:36

I like to ask is, what do you think the future of telehealth looks like?

Sarah: 00:28:41

Yeah.

Sarah: 00:28:41

I've always like worked on telehealth, so I always saw the potential of it.

Sarah: 00:28:45

I've said, gosh, it got, some people say it got pushed

Sarah: 00:28:47

five years in the future, 10.

Sarah: 00:28:48

To me it felt like 20 because the reimbursement changed, right?

Sarah: 00:28:51

The licensure hasn't, but the reimbursement changed.

Sarah: 00:28:53

So I think I will say wherever the technology.

Sarah: 00:28:58

Whether that's ai, all that.

Sarah: 00:29:00

I think that's where telehealth looks.

Sarah: 00:29:02

So when I would first go out and do telehealth speeches, I had to explain

Sarah: 00:29:08

what telemedicine was and telehealth was a new concept cuz it was more than doctors.

Sarah: 00:29:12

And I would have to define it and try to explain it and people would look

Sarah: 00:29:15

at me and go, That's so interesting.

Sarah: 00:29:17

Wow.

Sarah: 00:29:17

That's low cutting edge.

Sarah: 00:29:18

And then give it a couple years later, I was saying, Yeah.

Sarah: 00:29:20

And you could do it on your.

Sarah: 00:29:21

It Cause there was an iPad.

Sarah: 00:29:23

We didn't have iPad so far.

Sarah: 00:29:24

Then we had, because it was webcams before, it was like I didn't, like

Sarah: 00:29:28

I didn't have a camera in my laptop before, but now I need it every day.

Sarah: 00:29:33

I don't know a hundred percent what it will look like in that way, but I do know

Sarah: 00:29:40

it will evolve as technology evolves.

Sarah: 00:29:42

What I'm seeing out in the market is it being what we call like a virtual

Sarah: 00:29:47

care integration is happening where people are trying to marry what we

Sarah: 00:29:52

call like bricks and mortar, going into a building to not going into a

Sarah: 00:29:57

building and doing it some other way.

Sarah: 00:30:00

And whether that's a text reminder appointment reminder, whether that's

Sarah: 00:30:03

a coach call cuz they can tell your glucose got to a certain thing

Sarah: 00:30:07

and someone calls, whatever that.

Sarah: 00:30:09

I think that's where we're, that's where we're headed.

Sarah: 00:30:11

So I don't think telehealth will be the simple telehealth.

Sarah: 00:30:15

I think it will be integrated in and we'll have to figure out how that looks,

Sarah: 00:30:19

if that changes the care protocols and if it changes reimbursement.

Sarah: 00:30:23

But I don't, given the federal laws are gonna stick, then in

Sarah: 00:30:28

reimbursement's gonna stay around.

Sarah: 00:30:30

If those things are all true then it looks, Yeah, it looks it.

Sarah: 00:30:34

like it becomes part of our care delivery.

Danielle: 00:30:37

Mm-hmm.

Danielle: 00:30:37

, , which I think is very exciting.

Sarah: 00:30:39

It, it is.

Sarah: 00:30:39

And again, we just don't lose sight of the leaving people behind part of it.

Sarah: 00:30:43

We don't get so excited that we go, we forget that there are

Sarah: 00:30:47

other people out there that we're might be, we might be missing.

Sarah: 00:30:51

And I think one more other thing to add out there that I'm, we see a lot

Sarah: 00:30:54

is the, you know what we talked about data and is like the value of data.

Sarah: 00:30:59

Our laws around not being able to sell data, but yet the value of

Sarah: 00:31:03

it and the compliance around that.

Sarah: 00:31:05

And whether there ultimately we will be, there's was talk about an agency

Sarah: 00:31:09

around AI or an agency around data privacy that was agnostic to healthcare.

Sarah: 00:31:16

And so those things will impact those bigger national policy issues.

Sarah: 00:31:22

Will.

Sarah: 00:31:22

ends up being a day to day interaction on telehealth.

Sarah: 00:31:25

So keep an eye on that.

Sarah: 00:31:26

Even if you look at the Department of Health and Human Services they have a

Sarah: 00:31:29

group looking at artificial intelligence, so it's not even for themselves.

Sarah: 00:31:33

If you look at like the office.

Sarah: 00:31:35

For Inspector General that does the audits of healthcare payments, they are

Sarah: 00:31:39

using AI algorithms to ch detect fraud.

Sarah: 00:31:41

So just know that, like the future of telehealth, I think it does look bright,

Sarah: 00:31:45

we still have the laws out there.

Sarah: 00:31:47

We still have national policy and other items, so it's, it, it may be regulated

Sarah: 00:31:51

in a different way than I can even anticipate sitting here right now as well.

Sarah: 00:31:56

But I do think, I don't see it going away and honestly, I didn't see it going away.

Sarah: 00:32:00

Even in 2020, because it's once you roll something out to somebody, it's really

Sarah: 00:32:03

hard in healthcare to take it away.

Danielle: 00:32:05

Yeah.

Danielle: 00:32:06

Particularly when people like how convenient.

Sarah: 00:32:08

Yes.

Danielle: 00:32:09

All right, we're coming up on time here.

Danielle: 00:32:12

So is there anything else you want to touch on before I log us off, as it were

Sarah: 00:32:16

yes.

Sarah: 00:32:17

First of all, I wanna thank you so much for having me, because as you

Sarah: 00:32:19

can, I very much care about this topic.

Sarah: 00:32:21

And and I really hate to be the doom and gloom lawyer.

Sarah: 00:32:24

Type on, on, on these, like sometimes people take the power if they ever

Sarah: 00:32:27

have a PowerPoint and then there's like a slide with someone in jail

Sarah: 00:32:29

and they're like, Don't do this.

Sarah: 00:32:30

And then you're like, See jail.

Sarah: 00:32:31

There aren't laws that actually could put you in jail, in healthcare,

Sarah: 00:32:34

yes, they do exist but I don't want people to feel stunted by it.

Sarah: 00:32:37

It's if you really are feeling that stunted by it, it's make sure you have a

Sarah: 00:32:41

good attorney or make sure you have good.

Sarah: 00:32:43

In house or do you know don't get stalled out by it cuz there,

Sarah: 00:32:47

there are things that you can, do and then do it in compliant ways.

Sarah: 00:32:49

There's models out there, and also at the others say time.

Sarah: 00:32:52

I would say don't go out there and just do whatever you want because.

Sarah: 00:32:56

You're, and it's a, it's on the OIG work plan to audit these, there's

Sarah: 00:32:59

gonna be enforcement around it.

Sarah: 00:33:01

But also don't not do it because you're worried about being, and

Sarah: 00:33:04

you just do it the right way.

Sarah: 00:33:05

People are doing it the right way.

Sarah: 00:33:06

It's possible to do it.

Sarah: 00:33:07

And and I think that's the message I wanted to say to everybody because

Sarah: 00:33:10

when I go to conferences where there's not a lot of lawyers, I

Sarah: 00:33:13

just get the are we gonna get sued?

Sarah: 00:33:14

Are we gonna get in trouble?

Sarah: 00:33:15

I just hear that people literally say that on stages, and I just

Sarah: 00:33:18

wanna say, you can figure this out.

Sarah: 00:33:21

It's not, I'm not saying it's easy, I'm just saying it is absolutely doable.

Sarah: 00:33:25

and in, in, in the right way.

Sarah: 00:33:26

And and also just to get out and talk to, if you have a, to have a voice in

Sarah: 00:33:31

this, because I think the more we get out and talk about it, the more normalize

Sarah: 00:33:34

it gets, whether about health equity or whatever you're passionate about, care,

Sarah: 00:33:38

virtual care, telehealth, Because the more we talk about it, the more the policy

Sarah: 00:33:42

makers hear us and the more normalize it gets because that's how policy changes.

Sarah: 00:33:47

And if you have an opportunity, Through your attorney or an advocate,

Sarah: 00:33:51

an association, wherever you have a voice, get out there and talk and say it

Sarah: 00:33:56

because that really will make a change.

Sarah: 00:33:58

If we sit quiet about these things, the change won't happen.

Sarah: 00:34:01

So use your resources out there.

Danielle: 00:34:04

I can't sit here with our fingers crossed

Sarah: 00:34:06

Not gonna just happen.

Sarah: 00:34:07

I wish that's the way it worked, but it doesn't.

Danielle: 00:34:09

Certainly be easier.

Danielle: 00:34:10

Thank you so much for joining us today.

Danielle: 00:34:12

I don't typically get to discuss health and healthcare from a legal perspective,

Danielle: 00:34:16

so I really appreciate you coming on and touching on those topics with me today.

Sarah: 00:34:20

Great.

Sarah: 00:34:20

Thank you.

Sarah: 00:34:21

Thank you for having me.