The outbreak of COVID-19 is changing the world, in both the present and in the future. In these uncertain times, hospitals and other healthcare facilities are looking to implement new technologies to continue to provide services, while limiting their face-to-face interaction. But implementing HIPAA-compliant and insurance-approved telehealth applications in a short amount of time can prove to be a challenge. Thankfully, the federal government is lifting rules and reevaluating their regulations to allow healthcare companies to use other tools to reach their patients in these difficult times. On this episode of Inside Reproductive Health, Griffin talks to Jill Gordon and Sarah Swank, lawyers in the healthcare division of Nixon Peabody. They navigate the changes to insurance, licensing, and HIPAA regulations in the midst of the COVID-19 crisis and how clinics can appropriately implement telehealth to help their patients through their journeys without seeing them in office.
Learn more about Nixon Peabody or contact Jill Gordon (jgordon@nixonpeabody.com, or 213-629-6175) and Sarah Swank (sswank@nixonpeabody.com, or 202-585-8500) for more information on implementing telemedicine at your clinic.
To get started on a marketing plan for your company, complete the Goal and Competitive Diagnostic at FertilityBridge.com.
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Welcome to Inside Reproductive Health, the shoptalk of the fertility field. Here, you'll hear authentic and unscripted conversations about practice management, patient relations, and business development from the most forward-thinking experts in our field.
Wall Street and Silicon Valley both want your patients, but there is a plan if you're willing to take action. Visit fertilitybridge.com to learn about the first piece of building a Fertility Marketing System--The Goal and Competitive Diagnostic. Now, here's the founder of Fertility Bridge and the host of Inside Reproductive Health, Griffin Jones.
JONES 1:00
Today on Inside Reproductive Health, I'm joined by Jill Gordon and Sarah Swank of the healthcare division of Nixon Peabody LLP, which is a global law firm. Jill Gordon represents a wide range of health care clients, including those in the health information and telehealth fields with transactional and regulatory matters. Jill partners with various health care providers and suppliers, as well as emerging companies with respect to the creation of new products and services within the traditional health care market that have some digital health components, such as sensor technology, remote monitoring, health-related apps or other forms of software. Sarah, as a former senior in-house counsel for two national healthcare systems, provides strategic regulatory and operational advice to health systems, hospitals, and academic medical centers, as well as large national and regional physician organizations in telehealth and other startups. Ms. Swank, Ms. Gordon, Sarah and Jill, Welcome to Inside Reproductive Health.
JILL GORDON 1:57
Thank you for having us.
JONES 2:00
I’m really happy to have you on because as I was mentioning to you before we started recording, normally we batch episodes, and they're sort of evergreen content. And that's all been put aside with the whirlwind that we're in now. And you were both kind enough to come on, because clinics are scrambling to get onto telehealth platforms as quickly as they can. And this is something that I mostly stayed clear of in our consulting that I always felt like as we get deeper into our practice area, I wanted to be able to, to offer some more guidance and to direct to folks like you, but just hadn't ever gotten around to it and now it's really on all of our laps. And so, what have you both been seeing in the past two weeks that maybe you weren't seeing before? Just how have things been accelerating?
SARAH SWANK 2:56
I think one of the things that's been really interesting is with COVID-19 is the idea of not necessarily wanting patients waiting in waiting rooms, something that we never thought of before, right? I mean that you go to your doctor appointment and you wait in the waiting room. And so with this new CDC advice and this new guidance that came out around telehealth, we're looking at the idea that we don't necessarily want patients to go to their visits in person every time, right?
JONES 3:24
Well, Jill, I had seen you speak before and one of the things that had sort of steered me away from telehealth before was that there's just other regulations to consider that one might not have to consider with respect to treating a patient in the office. For example--if I'm understanding correctly--I'm in Illinois, and I see a patient from Michigan. I don't need to be licensed to practice in Michigan if they're coming to my office, but if I'm seeing them from their home in Michigan via telehealth health, and I'm Illinois, then the requirements are different. Do I understand that correctly?
GORDON 4:00
Yeah, I think that's right. I mean, one of the big barriers to entry, historically, to help to telehealth was if you were actually seeing patients cross border--meaning cross state borders--where the patient is actually located is viewed as the jurisdiction where the physician needs to be licensed to practice medicine, not where the physician is actually sitting. And to kind of further complicate that, if the practitioner is working through some type of corporate entity, like a medical group, that medical group also needs to be qualified to do business and practice medicine in the state where the patient is sitting at the time of the visit. So that's been a huge barrier to this. I think most people think about privacy issues and HIPAA, but it's really the practice of medicine laws that have kind of impeded the ability of practitioners to do a lot of this work cross-border into other states.
JONES 5:05
So what do they need to do? Do they just say okay, we're not seeing patients from out of state? Are there other ways of obtaining qualifications, licenses? How do you normally see people responding to this? Is it sort of an all or nothing game where most people are saying okay, we're only gonna do telehealth consults for those in our states and others are trying to get licensed in every state so that they can win the overall market?
GORDON 5:39
So, I think it really depends on your business plan as a provider. Most providers know what jurisdictions they pull from, and if they've got primarily an office-based practice and they're seeing patients cross-border from neighboring states or certain jurisdictions all the time, then they set up to be able to qualify in those states. There are a number of just pure telehealth networks that are trying to qualify in every state so they can be kind of a plug-and-play and provide that as an option. I think what's really interesting now--and also this dynamic where there's a difference between individual practitioner licensure and qualifications, which actually a number of states have compacts now, which don't require individual physicians to go through licensing in every state. And they can qualify in one, which might mean that they have qualifications in multiple, but we still have this entity issue, which is somewhat frustrating. It doesn't actually get highlighted very much when you look at trade association publications.
JONES 6:50
I saw that you both had sent me a newsletter from your firm Nixon Peabody that talked about some of the changes that are happening right now. And it brought to light something that I thought was going to happen and I've been telling clients, I’ve said, Listen, this is not legal advice at all because I'm not qualified to give that and it might even be lousy advice, but I imagine that now is the time to to start embracing telehealth because regulatory bodies will be more lax and forgiving as people are figuring this out. And then I'm reading in your newsletter enforcement flexibility that it will allow providers to offer free telehealth services through widely available smartphone applications like Skype and FaceTime. That seems like a HIPAA sort of exemption if you will--I don't know if exemption is the right word. And then another condition is that greater cross state licensure exemptions during the outbreak to allow healthcare providers to render services including telehealth services across state lines. Who is this all coming from?
GORDON 7:59
Sarah, do you want to turf that?
SWANK 8:08
So where is it coming from? Well, hopefully ultimately, it's coming from the CDC in some way, but it's coming from--the first action that happened was a congressional action, which started funding telehealth without yet guidance so that there'd be coverage for Medicare. So that was the first thing that happened. And then CMS, Centers for Medicare and Medicaid Services, just came out with guidance around coverage. And previously, they wouldn't cover, for example, if a patient was at home, and so that's a huge change. Now that whether the centers would be covered by Medicare, I think that's not necessarily what's important here, I think what's important is it's opening up people--maybe providers, social workers, physicians, and others who maybe were a little afraid to go into telehealth. And the same with patients, so that I think there'll be a cultural shift after this, that maybe there'll be more providers and more patients that are willing to use telehealth applications. And that was one of the fears that they had. I know Jilll and I were talking last night about the HIPAA implications and I don’t know, Jill, if you want to talk a little bit about that.
GORDON 9:20
Sure. So yeah, I think I mean, to kind of put a finer point on Sarah's comments. The what's happening right now with the rules around telehealth is mostly a change in Medicare policy. That I mean, that's not going to be that important for this audience, because typically, they don't bill and participate in the Medicare program, but I think it's important from a more political and sort of global perspective because typically, commercial insurance plans follow the lead of Medicare. So historically, Medicare has had very limited recognition of telehealth services and what they would reimburse and what they would actually allow as a covered service. Now, most recently, the rules have changed around that to really open that up to allow use of telehealth in all different types of locations and different types of providers to be able to use it and also to get reimbursement. So, while I think prior to that, you've seen a lot of commercial health insurance plans cover telehealth services, this just further provides additional support for that. On the privacy side and the HIPAA side, the other thing we've seen is that the Office of Civil Rights has really relaxed enforcement of HIPAA around telehealth standards. And so what they are now saying is don't worry about having a HIPAA compliant platform in order to engage into telehealth and to have telecommunications. I think if you're a provider right now, even trying to get the attention of a platform supplier and vendor is going to be really hard because they're totally overwhelmed with requests for services. So, Office of Civil Rights has issued guidance that is basically saying for this period in time, they're waiving HIPAA compliance for use of telehealth modalities and so things like FaceTime and Skype are going to be okay. Whereas historically, they weren't viewed as being HIPAA-compliant because they're not necessarily secure, or meeting the security requirements.
JONES 11:42
I guess I hadn't considered how overwhelmed the platforms would be. I knew that they would be booming with business, but I didn't see that as being the reason for expanding this allowance to non-compliant platforms. I thought that largely that reasoning might be the learning curve could be too steep and we just want you getting people out of the office right now so that we're gonna allow it. And there are a lot of different companies like eClinicalWorks as an offering, Doximity has an offering, Telehealth, which just was acquired by TeleDoc, has an offering. But is that what you're noticing, Jill, that these companies are so overwhelmed that they aren't even--that they're just so backed up in taking on new orders?
GORDON 12:27
I've heard that they're very backed up. I have a friend that works over at InTouch, and they just announced a merger withTeleDoc, and I think that they're completely overwhelmed with demand. And I'm sure some of the other platforms are as well. I think the other thing is, we just don't have time for implementation and setting that up. And so I think there’s a recognition that we want to keep people out of a waiting room as much as possible and go instantly to some type of remote communication because it's just safer. And so they wanted to facilitate that as much as possible--the Feds did.
JONES 13:11
So these rules are mostly about Medicare and you mentioned that the commercial insurance plans typically follow the lead of Medicare. To your knowledge do you know, are most of them--have most of them followed this or all of them followed this? I have heard that Blue Cross Blue Shield have said we'll reimburse for FaceTime and Skype--I don't want to say that as the end all be all. Anyone listening should talk with their insurance companies before heeding that. But are you finding that virtually everyone has it, or is the domino still falling?
GORDON 13:52
It's hard to say because, kind of before all of this happened, there was a patchwork of coverage and different payers based some on state law and requirements under state law for parody for telehealth coverage, were already paying for visits. And so to the extent that payers now are paying for visits that haven't historically, it's really going to be on a case-by-case basis, payer-by-payer, state-by-state. So it's hard to say, but the sort of wave of intention is out there. And it's hard for them to say no, particularly given the circumstances.
SWANK 14:37
Yeah, it should be interesting because the coverage for Medicare--which again, it could just be precedent, or it might not--is for an actual visit, like they use the same codes for an office visit or a new visit or a virtual visit or a check-in visit. So I think that will be really interesting to see if the commercial payers will then pay at the same level as an actual office visit, as opposed to a telehealth visit.
JONES 15:04
Yeah, so that's still unknown is what you're saying, Sarah?
SWANK 15:08
I think I think we'll see. I think Jill's absolutely right. It's always been a little bit of a patchwork of what plans in what states and what markets would pay for what products even. I mean, it can be very specific. But I think we'll see, you know--at the end of the day, we're going to look at probably physician shortages and clinician shortages. And so our system is set up to look at communities and markets and states and ultimately, we're going to have to look at this as a country. And so you'll start seeing things like hopefully, the governor's will get together and say--or at least one by one--hopefully saying these licensure rules across states, we can't have that right now because it's going to block telehealth, for example, or block the movement of physicians to surge areas. And so I'm hoping, I think that will probably open things up, too. And if commercial insurers start looking at it in this patchwork way and don't have to start looking at this as our country, and our patients across our country, I think it will fit. It's like we have to act now. We don't have the time to have people think about it in three weeks.
JONES 16:19
So it seems that these changes are so overdue. It's unfortunate that it took a scenario like this to bring it into fruition, but it seems like the legislation has been so cumbersome, that it took something like this in order to be able to get us here. And I wonder, you mentioned Sarah, that this could cause a big shift in the cultural habits and I certainly believe that. Do you think it will also cause some lasting change in the legislation, not just with the state laws, but also with HIPAA?
SWANK 17:05
Yeah, I mean, it should be interesting. I think, first of all, we have congressional action that's covering this and the coverage period is during this pandemic period. So if we look at H1N1, the Swine Flu in 2009, that was a pandemic and the pandemic ended. So these laws and changes are technically tied to a pandemic designation that we're under right now. So when that goes away, it will be interesting to see what happens because people will have gotten--I think also, if you look at the culture is I don't know if people are going to be getting on planes, or wanting to go into doctors’ offices in the same way right after, even after, if we're lucky enough to be out of this pandemic soon, would be--I just don't know if that people are going to be--we're going to have to like heal as a country, as a world. And so I think, even if the designation goes away, I think people are going to maybe be a little bit scared or cautious about things that we did before that. And so it just seems to me that the legislation, Congressbasically, our states, commercial payers in our country will have to look at this and say, Were there lasting effects? Or is there data out of this that can show that this will work? And hopefully some of these changes will stay in place. Because I agree with you, in some ways, these have been long overdue, and obviously it would have been better that we had them in place prior to this, but maybe there can be a silver lining out of this.
JONES 18:38
I'm hoping so. And I'm certainly hoping so for HIPAA! You mentioned the H1N1 pandemic had similar designations, and that was in 2009. Since then, the voice over internet protocol in video software has advanced tremendously since that time--broadband. We've also seen the coming of age of millennials. So at that time-- I’m among the earlier millennials--so we were in the workforce, some of us, but we were brand new and we were in our earlier 20s. Now many of us are at the director level, some are at the principal and executive level. And I just see, you know, if I could just tell you as a lay person, I think HIPAA is something that is just unswallowable for many millennials the way it's written. And when I first started the firm five years ago, I was so curious about the social media applications of HIPAA and the digital marketing applications of HIPAA, and I interviewed eight different attorneys and one of whom was from your firm who gave me the best guidance that they could and I was still left almost as confused as when I had started because, to me, it seems a just such an oppressive piece of legislation with respect to digital media and social media. I had an attorney walk me through the HIPAA law over a two hour video call. And I said, So, okay, so what you just explained to me is that a Google My Business listing, if a patient posted there, if I as a practice claim with Google, my business listing and a patient comments on it, that that's exposure to to PHI if they if they don't have HIPAA authorization signed. And so I'm hoping that that we could see some changes with HIPAA because as a lay person, it's unnavigable, I believe, and I believe it's also--I almost never see anyone comply with it to the fullest because I just don't believe that they can. Was there any appetite before this--was there any grumblings about updating digital media and social media applications in HIPAA and what PHI is? Or do you think some will come from that now?
GORDON 21:10
Well, I think it was almost moving in the opposite direction before this happened, because you saw the state of California passed additional privacy rules that were more in line with the limitations in Europe and what's happening with the Google and Ascension partnership around that health system and the concern by Congress about Google having access to medical records at Ascension and what the purpose was and whether it was legitimate. So I think before this, we almost had--we definitely were moving towards more regulation around privacy and individual rights around ownership of one's own medical history. I think that the interesting thing--and it's really hard--like if you take a step back, just philosophically, right, we have all of these laws, because they're coming from a consumer protection standpoint. And some of them also are really old. And we're coming from a business protection standpoint, where you had medical boards of various states that were really interested in protecting, not just their citizens by requiring licensure and qualifications and limiting who from outside the state can provide services, but also that was a protection for clinicians within the state. So it was an anti-competitive role, right? And so we're dealing with a framework that is a century old of ideas about practicing medicine and laws that were put in place and, unfortunately, our system, the way we do things, is not repeal the law usually, and take things away, we just create more law to overlay on top of it, which is why you've got this confusion and sort of multi-layers of different jurisdictions having different rules, and then different agencies, passing things that don't necessarily reconcile. It takes a pandemic like this to really level the playing field because what effectively is happening is you have government agencies at various levels on the federal, state, county, city, that are basically saying, forget what's in place right now--we're in a state of emergency, so this is what we should do. And that's really freeing from a regulatory standpoint. But when, I think as Sarah mentioned, when the pandemic ends, we're not starting with a clear field to do what makes sense, we're going back to the existing framework and then trying to move forward from that, which is a really kind of awkward process and it's hard for democracy to kind of get out of its own way, right? Because the law that we pass, ends up having a lot of stakeholder viewpoints, and it's not necessarily the most efficient, best way to go about something.
JONES 24:24
Sarah, you mentioned that there was a similar designation for the H1N1 pandemic in 2009, about how long did that last?
SWANK 24:31
That was a year. And I mean, I'm not a public health official. So I'll disclaim this, but I did live through it being an in-house counsel in the Washington DC area. And I think what was interesting about that two things, one, it was more it was more seasonal. So we saw a typical influenza season. The numbers started naturally going down around April. And then the other thing is that bought time for a vaccine. So I do remember when the vaccine came out here was a shortage of it. They had to designate who would get it and who wouldn't--like, those who are caring for people, and those that were critically ill were designated to get it first. And then it slowly rolled out. And then what I think some people may have forgotten was then that shot that everyone wanted, ended up in our flu shot each year. And I think we just, kind of, culturally forgot about it. We just said, Okay, there's no H1N1, we were worried about it, everyone wanted the shot, and then it just became part of the flu shot. I think one thing that was interesting about--I just go back to HIPAA for a second and I definitely do not want to talk about HIPAA for two hours--but to talk about it for a moment! I don’t think anyone wants to talk about HIPAA for two hours, I probably have before--but just to give a little context, it came out in 1996. If you had a pre-existing condition and you switched jobs, you didn't have coverage. We also didn't have claims processed electronically-- they were like on paper. And so that was really what Congress was trying to do. And so we had then two sets of regulations, the privacy rule that came out in 2002 that said, okay, safeguard things. And some of this weird, a little bit of an interesting way to write a regulation where instead of saying, here's the rule, and here are the exceptions, it's just really complicated. And then they came out in 2003, a year later, with a security rule. And at the time, they had to decide, Okay, are we all going to be on one electronic medical record or not? And if you read the comments to that rule--which you might not want to do, they're very long--but I will tell you what they say they say, we want to spur innovation. We don't want to, like lock someone down to one way to do technology because we think it will change. That's a great thing to say, right? That's what you want. That's what you're talking about, tight? But what I think happened was the opposite happened. It almost meant that innovation didn't quite happen in the same way and yet the government got nervous about it and then enforced it more. So now technology has like--we all can pick--if we have broadband, we can pick up our phone and talk to anybody at any time if they have broadband on the other side. And that was definitely not contemplated at all in 2003. But what's interesting is the government now is worried about that level of security. And again, it's consumer protection, like Jilll said. I mean, the Congress is considering doing a data and data protection agency across industries right before this happened. So it should be I mean, it shouldn't be interesting. There's a law that basically tells you that based on the technology, you should have that level of security. So as technology gets better, and security gets less expensive, you should have it. The problem is there's a telehealth surge, just like there's a hospital surge and we can't keep up with the demand, so we have to go on a less secure platform. I think that's what the government's trying to say. But then if we decide telehealth is really amazing, either there needs to be a lot more telehealth companies, or FaceTime needs to become more secure, or we won't be able to do this in the same way afterwards.
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JONES 30:15
To Jill's point about California was moving in the direction of GDPR--which is the legislation in Europe, the privacy legislation to protect consumer privacy, that one's own data is one's own. And I think that's fine, but it would it's an oversight to not couple with that implicit consent in the age of social media and digital media. So as far as I understand in HIPAA, but there's no such thing as implicit consent. Unless I sign a HIPAA authorization, it is still protected health information, even if I'm the one posting my data on the comment section of someone's website or their Google review listing or their Facebook page or their Instagram account. If I'm posting that information is still technically protected health information on a property of the provider. And I think that is something that really, I would hope would be addressed. Maybe it will, maybe it won't, as all of this advances. But when, as Jill also mentioned, when this designation was lifted, we didn't just get to say, here's what we learned and we're able to function with well, we went back to democracy as normal. Did anything change from that 2009 designation that legislators then adapted in the law?
SWANK 31:48
There, you know, to be honest with you, the laws and the waivers that are happening, they're called 1135 waivers, which are basically Medicare is out of the Social Security Act, and there's a designate nation that you set up these laws and there's times in which you can waive them and once when we declare a national emergency, which the President did. And so we're in unprecedented times, I don't know about you, Jill, but the legal changes that are coming at us are--these are getting Medicare laws--but they're, if they're unprecedented in like, definitely my career, and it may be-- They're looking at this and saying, looking at this like the flu of 1918. I mean, we're in a different time right now. So we can try to take our crystal ball and guess what will happen, but, you know, in 2009, really, the issues were around, kind of, the same as like a influenza surge, which happens sometimes when the flu shots aren't as good or, or there's just a bad year for it. This is the next level. So we are in unprecedented times. I don't know what you think, Jill.
GORDON 32:54
We’re not just seeing this out of CMS and the Medicare program but other aspects of this. We've seen the DEA, particularly around telehealth, waive certain requirements for initial in-person visits for online prescribing of drugs, which was a super controversial issue in the past and now we see a waiver to that. So there doesn't have to be a pre-established patient relationship in-person before someone can prescribe drugs online. The other thing that we're seeing is clinical trials. The FDA is asking people to try to participate in clinical trials remotely, which was another really controversial issue in the past and so we're seeing just kind of all of these things fall away. [It’s] really driven by necessity and the desire to keep people at a distance. And telehealth has not taken off mostly because of an economic issue, because I think the federal government was viewing the modality of communication as potentially adding cost to the system. And what you were seeing from the private markets was a real push to two things. One was physicians were saying, actually, this is a more efficient and less expensive way to take care of people, and therefore we want to use it and we think it's cheaper. And the other thing is that folks in the public health world were saying, this makes a lot of sense because you can really improve access, particularly for people who have mobility issues, who don't have necessary transportation--it solves a lot of things for access to care. But you know, effectively, the Feds meaning you know, Medicare wasn't buying it, Medicaid in various states depending on state-by-state, some cover it, some didn't, most of them covered it in more of a managed care environment where the state wasn't absorbing additional cost for use of the modality. So, you know, we were talking about this, Sara and I, before. I think this is, in some ways it's a testing ground to see if this form of care is actually going to meet demand, create access, and also be more efficient. And if people think that's the case, I would expect that we're going to see more permanent expansion of it. But if there continues to be a view that it's just adding cost to the system and creating more visits, that may not be medically necessary, then I think there's a good chance we could go back to business as usual.
JONES 35:50
And if we do go back to business as usual, Jill, is it possible for those companies that don't have a telemedicine provider that wants to use a non-secure channel or non-HIPAA compliant channels such as maybe FaceTime or Skype, is it possible for them to use a HIPAA authorization as a means of being--if I have the patient sign a HIPAA off, is it possible to then use those channels?
GORDON 36:20
So, this is getting a little bit into technical weeds in terms of HIPAA compliance. So, whether a healthcare provider qualifies or falls under HIPAA as a covered entity in the first place has to do with what payers they bill and whether they have the ability to opt-out. Specifically under HIPAA if a practice is 100% cash pay, there is, based on the rules under HIPAA, there's a way to kind of opt-out as a covered entity. But if a practice bills any commercial insurance whatsoever, then I think it's harder to get out from under compliance. Any exchange of information between a patient and provider is the patient's sort of election to share that information. Ideally, you want to have a platform where that information is being shared that's secure and meets the security requirements of HIPAA in the event that you have a data breach. If for whatever reason, it's impossible to do or you have patients who are refusing to use a designated platform and would prefer to use Skype or FaceTime or something like that, I think it's always best practices to have informed consent from patients. That being said, once a provider has that information, to the extent that they're transmitting it to another third party, HIPAA would always apply.
JONES 38:02
Are either of you familiar with any forms of documentation that are required? I had one doctor ask me--because typically, the telemedicine had been reimbursed and phone call consults had not and so I had one physician ask me, Do I need to take a screenshot of the consult happening in video? And so I wonder are you familiar with any other documentation that's typically required for telemedicine or if you know anything about that specific idea?
GORDON 38:35
Like to get paid? Is that what you're asking?
JONES 38:37
Yes.
GORDON 38:36
So once we're outside of the federal programs--and I think most of your listeners are going to be outside the federal programs because the Medicare and Medicaid programs have very specific rules about documentation and what they cover, and how to get paid--once you're outside of that world, if you're in a pure cash pay environment, typically the telehealth rules that would apply in documentation is going to be based on state law. And then you would also, if you're billing any kind of commercial health plan, those plans may have their own rules around that and you would look at your provider contracts to see what would be required or the handbook or manual that goes along with that particular insurance plan.
JONES 39:35
Sara and Jill, how would you want to conclude with our audience as they scramble right now to adopt telemedicine to try to be as compliant, to be as forward thinking as possible? What are the considerations that you would both advise people if you're going off a quick checklist with people? How would you want to conclude?
GORDON 39:55
I think given the current environment and the waivers of compliance with HIPAA and some of the relaxation of rules around from the DEA and the FDA with respect to trials, I think right now is a really good opportunity to adopt some form of telehealth technology and start using it and get clients used to it. I think that if I were a provider, I would be adopting things now with the eye that these rules are going to come back in place with the expectation that HIPAA as it previously existed is going to be required, and that the payment mechanisms may not be there once we no longer have emergency conditions. And so I think this is a good time to experiment with something, put in place what you can, you have a lot of latitude, and move towards a more compliant system, if that's possible. Because I think ultimately, that that's where this will probably end back up being in terms of having to follow certain rules.
SWANK 41:09
I’d agree with that. And I guess what I'd add to that is, I know we're in a pandemic, and we're all in some way being impacted by it. And we're watching the news every day and seeing the articles and you can look at a map and look at the surges that are going to start happening and the hospitals preparing as they put tents out--I think with all that still, I know we have to act fast, but still take that moment to make sure that you're thinking through how you're going to roll this out. Still take that moment to do it in a thoughtful way. I'd also say check in on your patience, too. I mean, you know, one of the things that I thought was really wonderful to see--again, this is Medicare guidance--but something that I thought was just wonderful was on social workers and psychologists and others that can be available for people that may be in a vulnerable state. And I think we should maybe think about building on that when you build out your program, think about the full amount of services that somebody, one of your patients may need so that you can support them and be able to do that maybe through a telehealth solution.
JONES 42:15
Jill Gordon and Sarah Swank are both from the firm Nixon Peabody. We're going to link to their contact information because if you need help with counsel, you have two experts right here that I highly recommend. So I'm going to have their contact information in the show notes. Jill Gordon is West Coast, Sarah Swank is East Coast, both again from the firm Nixon Peabody. Jill. Sarah, thank you so much for coming on Inside Reproductive Health.
GORDON 42:39
Thanks, Griffin for having us. It's been a pleasure.
SWANK 42:42
Thank you.
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