COVID-19 Conversations From A Provider's Perspective

Moving Carefully When There's Pressure to Move Quickly

Three Virginia health system executives participated in a virtual discussion about COVID-19 from a provider’s perspective. The hour-long program was part of the 16th Annual Virginia Health Care Practitioners’ Roundtable sponsored by the Virginia Bar Association’s Health Law Section Oct. 22. Here is one summarized excerpt from that conversation.

Panelists:
   J. Corey Feist, CEO, University of Virginia Physicians Group
   Paul Neimeyer, Chief General Counsel, VCU Health System
   Lou Patalano, Chief Legal Officer, Sentara Healthcare
Moderator:
   Jonathan M. Joseph, Christian & Barton

[Jon Joseph] What types of COVID guidance are leaders in your organization requesting?

[Lou Patalano] There's a lot of federal and state regulatory action, and we have to keep up with it as best we can. In the early days of COVID it was a fire drill almost daily as something new was being proposed or coming out. We're all trying to decipher the maze together, and leadership saw us as a good resource and were regularly reaching out for input. A couple of months ago I noticed a trend of COVID-related matters layered with ‘how do we get back to business as usual’ questions.

[Jon] Corey, you're getting COVID questions from the medical staff. How is that impacting what you do?

[Corey Feist] The HR piece was a big one. The University of Virginia Health System implemented furloughs and across-the-board salary cuts in the May-June timeframe. There are multiple different employers within these entities, with different rules, such as rules associated with faculty, physicians, state employees or foundation employees. So there was a huge lean on our legal department to help navigate those policies and laws so that we could try to bring as much equity across the organization so that we are all contributing, if you will. It continues on a daily basis. We’re also working through federal-level issues, and as Lou alluded, how do you consider moving back to work? What are the new workplace employment rules?

To give a perspective in terms of work volume, the University of Virginia Health System took a dip when the governor closed health care systems to elective procedures. Graphed it looked like a “V” shape; volume took a big dip and now it has climbed back up. We’re seeing the layering of COVID and regulatory environment questions with uncertainty. So it's been it's been a daily effort without really an end in sight. It just keeps evolving.

[Jon] Paul are you seeing a movement back to normal?

[Paul Neimeyer] Definitely not back to normal. As Lou and Corey reflected, there was a quick pace of all the changes in the laws. So leadership needed answers within a short time frame because they needed to operationalize the changes to figure out a path forward. As Lou indicated, there are also day-to-day items on top of COVID. There are still purchasing matters, leases and employment agreements. You're still hiring. On top of this, I think what was key and helpful to us was making sure that legal compliance and government relations are all involved because we all touch on different legal aspects. So if you had somebody else keeping the list of all waivers that are going into effect, when they hit and when they end, that's helpful and leaves additional time for legal to do some other work on top of it. So I think it was really key to partner with your other people that deal with laws, regulation and accrediting bodies.

[Jon] From a legal department standpoint, has your work volume increased over this pandemic or is it about the same?

[Paul] It's definitely increased. You know legal departments are on call 24/7, just like physicians. My staff works weekends and nights to keep up with things. It's been a challenge. But, as I say to my staff, this is the same type of challenge faced by the clinicians. So we're in the same boat.

[Jon] Have you noticed projects slowing or getting put on hold during COVID?

[Paul] Our overall approach was not to slow, but continue to move forward. If you have been to our campus, we have a lot of construction going on. That was not going to stop. Vendor agreements still needed to be done. We purchased Tappahannock Hospital, which hopefully will become a part of the health system, and we were still moving on that and figuring out how to perform due diligence through COVID. So I think the overall message from my senior team was figure it out in terms of how we continue to keep doing what we need to do. We can't put a pause on anything just because of COVID. Let's also note that when this pandemic started, we didn’t know how long it was going to last and we still do not. You can't say we're going to put this on hold until COVID is over, because when's that? Two years from now? It's not realistic.

[Jon] Lou what's the perspective from Sentara in terms of projects?

[Lou] The projects didn't slow down, and like Paul, we're involved in deals—in fact the Cone Health deal was announced in the middle of all of this. We are also asked to look at the same project a couple of different ways. For example, we know how we would have done a project in the normal world and we still want to know how we'll do a project in the normal world. But now in the COVID world, we have to review the four different paths we might have to take to still get to the same outcome, which goes back to Paul's point of a 24/7 legal department operation. We're spending a lot of extra gray matter trying to look at alternatives so that we can compare the business for those different options. COVID has not slowed the pace of the projects but has added to the project complexity.

[Jon] Have you noticed any reduction in regulatory oversight, audits, things of that nature?

[Lou] I think CMS (Centers for Medicare and Medicaid Services) certainly noted a pause for a while, but within the last month said they're going to start some of their audits again. So I'd say that we did notice some reduction. But what I'm worried about is not audits going on right now; I'm worried about audits three years from now. The federal government may forget what we're living now and snap back to the pre-COVID regulatory way of looking at things. So I worry the empathy and sympathy that we all give each other right now we may not get three years from now because we will be in a new norm. And the new norm will probably have us powering in different ways.

[Jon] Corey, what's your perspective on government oversight? Have you noticed any pause at this point?

[Corey] There certainly has been some loosening of rules, such as with telemedicine. But I would say perhaps they're just maybe greyer on operations so I’m taking a similar approach as Lou. We are a relatively conservative institution when it comes to our legal opinions. We haven't blurred that line particularly when it comes to loans and the complexities in the law and the evolving nature of the law. We want to make sure that we are doing this as buttoned up as possible because a position has to be defensible three years from now when we're being audited. I think leadership has been receptive to moving carefully, particularly this past spring and summer when there was pressure to move quickly.

Other conversations in this series:

  • Practitioner Burnout
  • "If we tried to do it alone, it was not going to work."
  • Personal Connections in a Remote Environment

This summary has been edited for clarity and length. It has been provided as an informational service and does not constitute legal counsel or advice, which can only be rendered in the context of specific factual situations. If a legal issue should arise, please contact an attorney listed or retain the assistance of other competent legal counsel. Case results depend on a variety of factors unique to each case and results do not guarantee or predict a similar result in any future case undertaken.

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