Introduction (00:02):
Welcome to Health Law Talk, presented by Chehardy Sherman Williams Health Law, broken down through expert discussion, real client issues and real life experiences, breaking barriers to understanding complex health care issues is our job.

Conrad Meyer (00:23):
You going to be going to jazz fest at all?

Rory Bellina (00:26):
I’d like to. I just don’t know if it’s going to happen.

Conrad Meyer (00:29):
Are you a jazz fest kind of guy?

Rory Bellina (00:31):
It depends. It depends on who’s playing and when and what kid stuff is going on. I’d like to go, but we’ll see. It’s always a last minute decision if we go or not.

Conrad Meyer (00:40):
Man, I’m so spoiled. I had a client that used to have the Brass Pass and they had the private VIP tent and I got spoiled. So

Rory Bellina (00:52):
Once you have

Conrad Meyer (00:54):
Thatt, I don’t want to go back.

Rory Bellina (00:55):
Right. You can’t stand,

Conrad Meyer (00:55):
I mean standing around and thousands of people and it’s hot and it’s sweaty, and then you got the communal porta-potties that line. The perimeter. I just can’t do it.

Rory Bellina (01:07):
Yeah, yeah.

Conrad Meyer (01:08):
I mean, this one had private bathrooms, like the air conditioned bathrooms.

Rory Bellina (01:11):
We’ve got that this weekend. Zurich in town. Zurich’s in Zurich starts today.

Conrad Meyer (01:16):
Yeah. So let me play this out for you because this topic today is really good. So imagine you’re at Jazz Fest, right? You come in town, you’re from Colorado, okay? Okay. Colorado is a very, very free state when it comes to medical marijuana. That’s what we’re talking about today. Or marijuana in general, right?

Rory Bellina (01:30):
Sure.

Conrad Meyer (01:31):
And you have a legal medical cannabis card from Colorado. You go into Louisiana to a medical pharmacy, a marijuana pharmacy, and guess what? They can now legally serve you. How in the world does that happen?

Rory Bellina (01:47):
That’s changed because before this year that you would have not been able to do that. So that’s been a development, and I think people are excited about it. I think Louisiana looked at it as a way of, well, if all of these other states are issuing these out, we’re missing out on capitalizing on these patients. So if they’ve got a valid card and we believe it’s valid, then let’s serve them.

Conrad Meyer (02:09):
Well. Yeah. I mean, how many people, I mean, think about that. How many people at Jazz Fest that may be coming from out of town that do have this? I mean, I would think it would be very high.

Rory Bellina (02:22):
And other states I know are a lot more lenient and relaxed on how they issue these cards. Some states, I know states vary, but I don’t think they have as strict of a guidelines as Louisiana does. Louisiana has been a little bit more lenient recently in what they’re issuing the recommendations for, but I know other states aren’t as much. So it will definitely be an influx of business for Louisiana from people from another state. Because before this law that we are going to discuss, before this went into effect, if you wanted to get it from Louisiana and you’re a non Louisiana resident, you had to be a Louisiana resident. So that’s now changed. And even if you were a Louisiana resident at that point, then you had to have a visit or a consult or a TELEVISIT with a Louisiana provider and get that recommendation. And there was time involved in that. You couldn’t walk in the same day and usually get those visits. And so you would have to have the cost of that visit. And then it was just specific to Louisiana. So if you plan to never come back here, there’s a sunken cost in that. Now, if you’re, like you

Conrad Meyer (03:28):
Said it was a worthless visit. I mean, did you look at this websites mean Look, with all due respect, I know we had some guests before, but it’s not even, is it a visit really? Is it just

Rory Bellina (03:38):
Up to the providers? Up

Conrad Meyer (03:40):
To the providers and they get right. I get it. But you know what though? It’s legal. All of it’s legal. Andre doing it, right? They’re doing the virtual visit. You pay to play and you get your deal and you can get your gummies or what have you, right?

Rory Bellina (03:52):
Yeah.

Conrad Meyer (03:54):
But now you can be out of state. Now you can come in from a different state, and guess what? You don’t need to do that.

Rory Bellina (03:59):
Yeah, I’ve got the act right here in front of me. We were going through it before, but

Conrad Meyer (04:04):
What is that act?

Rory Bellina (04:05):
This is going to be ACT 4 38. 4 38. And

Conrad Meyer (04:09):
That’s been signed into love for Governor Landry, is that right?

Rory Bellina (04:11):
Yes. Yes. Wow. So it says that each a visiting qualifying patient may obtain medical marijuana from a marijuana pharmacy upon producing evidence of his valid medical marijuana registry card or its equivalent. So this has been, they’ve had changes to it. I think this act originally goes back to 2022, but then there’s been changes to it. And so that’s where

Conrad Meyer (04:36):
I saw that. So it started in 2022, but then I guess they must have reintroduced it in this year, or was it last year?

Rory Bellina (04:44):
Yeah, there’s been changes to it. I didn’t go through the full history. That’s,

Conrad Meyer (04:48):
But it’s signed into law now,

Rory Bellina (04:50):
Correct. Because before it was much more limited. They’ve made changes to it, and so I

Conrad Meyer (04:54):
Guess we’re expanding. Why don’t they just say, you know what? We’re going to legalize marijuana. I mean, why

Rory Bellina (04:59):
We’re, we’re going to

Conrad Meyer (05:00):
Get there. We just not jump through the hoops anymore.

Rory Bellina (05:03):
I think the change that they’ve added now is for this one, is that each time this out of stater, in your example for Colorado, they’re required to certify on a form approved by the board that they have been diagnosed with a debilitating condition. And then they have to list their name, address, phone number, and they have to sign off saying that they will not divert this to anyone else. So that’s the checks and balances, that’s the hook that’s been put into place. And that the pharmacies have to track this. They have to make a copy of the card, a copy of their driver’s license, and they have to retain these records as

Conrad Meyer (05:42):
Well. Got it.

Rory Bellina (05:43):
And they have to verify all this before they sell anything to them as well. And they have to also check to make sure that there’s no sort of issues with this patient. So a lot more work on the pharmacy side, but it opens up the doors literally to outstate

Conrad Meyer (05:59):
Patients now the tourist to Right. That come in him. Yeah. Well, you know what? I’m glad to see it expanding. I mean, I agree with you. At some point they just need to lay down and say, you know what? All these little hoops and things, because with it, that wasn’t the only bill. I mean, we’ve got multiple bills on this. So what’s the next one? I’m curious to

Rory Bellina (06:23):
See. Let’s talk about,

Conrad Meyer (06:24):
You want to go to the nps?

Rory Bellina (06:26):
Yeah, let’s talk about that one.

Conrad Meyer (06:28):
Everybody who knows an np, right? Y’all are going to have so many friends. I mean, the nps are going to be very popular people in Louisiana.

Rory Bellina (06:37):
So this one also dates back to 2022, but there’s been changes to it. So this is act 4, 4 4. And this

Conrad Meyer (06:44):
Again signed into law,

Rory Bellina (06:46):
Correct? Correct. Authorizes certain NPS and medical psychologists to evaluate and recommend patients for medical marijuana. So this one, let me go through this one and see what the changes were. But yeah, before it was, so the changes to the bill, which has now been written into law, it was that before it was defined as a physician had to do all of this, and they’ve scratched out the word physician and now they have licensed health.

Conrad Meyer (07:15):
But let’s say this wasn’t done in 2020. It looks like it was done in 2022.

Rory Bellina (07:21):
And now they’ve changed. They’ve made changes. And basically if you go through the changes, they have now removed most of the references to physician, and now it’ll either say licensed health professional, authorized, clinician authorized coalition.

Conrad Meyer (07:37):
So let’s be clear, this was passed in 2022, but went through a few minor changes and now is in

Rory Bellina (07:42):
Effect. Correct. So all the references where it says physician, physician’s order doctor, patient, now it’s clinician, clinician, patient relationship authorized clinician.

Conrad Meyer (07:52):
That’s unbelievable. I’m surprised that we didn’t get on this radar

Rory Bellina (07:56):
Before. So it’s interesting because the board of nursing typically takes a much more conservative approach on what they’ll, or they at least say their nurse practitioners can do. There are certain things that

Conrad Meyer (08:09):
Nurse, well, it’s not just them, it’s medical psychologists. So we can do both. We can do both. But yes.

Rory Bellina (08:14):
But this is an interesting expansion because before a lot of these clinics, when they needed someone to do these patient evaluations, you had to pay a doctor to do it, which obviously costs more. So I could see a lot of these companies that you mentioned, Conrad, that are doing these evaluations instead of now having a doctor on your staff. You can have an NP on your staff at more of a cost savings to you if hopefully that gets passed on to the patients, but now you have, so

Conrad Meyer (08:41):
The gummies might drop down 20%.

Rory Bellina (08:44):
I don’t know. Maybe the visit might drop down 20%. I don’t think the products are changing. Similar to ED departments, they have nurse practitioners and PAs, because doctors are just too expensive to staff it. Well, I could see where now there’s the

Conrad Meyer (08:57):
Value of this,

Rory Bellina (08:58):
There’s going to be the value, and you’ve got more NPS than MDs that want to do this. Probably. It’s going to be interesting though to see now the NPS insurances are going to have to cover this, and hopefully their insurances are caught up with this.

Conrad Meyer (09:11):
Okay, but how many medical malpractice suits you going to get from someone who received marijuana? I don’t see that happening. That’s

Rory Bellina (09:19):
Your realm.

Conrad Meyer (09:20):
I don’t know if that’s going to happen. That’s a little out there, but I could see.

Rory Bellina (09:24):
But if you recommended it for someone,

Conrad Meyer (09:26):
How are those nps though? Even if you had a friend, right? A friend of mine, if you friend with an np, suddenly those people are going to be hot topics, man.

Rory Bellina (09:34):
Or if you recommend it for someone that has an adverse reaction to it, here

Conrad Meyer (09:39):
Go get some gummies here. I’m going to write this script for you,

Rory Bellina (09:42):
Right? Yeah.

Conrad Meyer (09:43):
Oh my gosh.

Rory Bellina (09:43):
Yeah. Alright. That was a good one. That was a good one. I liked that. That was a good one. What else did we have in,

Conrad Meyer (09:50):
I like the one, so this is the one I really like here too. I have not seen this play out in the law enforcement realm, but

Rory Bellina (09:57):
Which one is this?

Conrad Meyer (09:58):
That 4 73 House Bill Act 4 73.

Rory Bellina (10:03):
Oh yeah.

Conrad Meyer (10:03):
You see this one? This is

Rory Bellina (10:05):
More of a criminal.

Conrad Meyer (10:06):
It’s a criminal thing. But look, it says house bill 6 29. Again, this is 2022. If this has been enacted, I would love for law enforcement or someone to let us know how this is. It’d be really interesting to see this, but it prohibits the search of an individual’s residence based solely on the smell of marijuana without a warrant. So you can no longer use smell of marijuana as probable cause to enter without a warrant.

Rory Bellina (10:34):
That’s interesting because I watch, I’m a huge fan of cops and all these TV shows a law order. You always see the police stops when I

Conrad Meyer (10:42):
Smell marijuana, I’m coming in.

Rory Bellina (10:43):
Or you get to stop that traffic stop and they smell marijuana and

Conrad Meyer (10:47):
Your car,

Rory Bellina (10:48):
There’s their PC to search the car.

Conrad Meyer (10:49):
Right.

Rory Bellina (10:50):
That’s interesting.

Conrad Meyer (10:51):
I would love to see if we ever have a law enforcement come on. I

Rory Bellina (10:55):
Would love, yeah, what’s their training been on this, or how’s their training now on traffic stop? Because that is a huge thing. And there’s also another one that I wanted to talk about similar. It was a house bill 2 34, which I think kind of piggybacks for. This prohibits passengers and motor vehicles or operators of motor vehicles from smoking or vaping while operating. Well, I

Conrad Meyer (11:18):
Agree. That’s common sense. It

Rory Bellina (11:20):
Is. It falls under the D-U-I-D-W. I think they’ve just caught up the legislation because before so much of it was

Conrad Meyer (11:26):
Designed, but So wait, but help me. I get that. But let me ask you this. How do you, okay, with alcohol, you have the breathalyzer, right? Right. You have the physical onsite test, whatever they do,

Rory Bellina (11:38):
And you have the smell of alcohol, but now you don’t have the smell of marijuana.

Conrad Meyer (11:42):
Well, but I guess the thing is, okay, a couple things. If your car is an extension of your home,

Rory Bellina (11:51):
Depending on who you ask, who

Conrad Meyer (11:53):
You asked, right? And now you have a bill in Louisiana says you can’t have PC for the odor of marijuana in your house without a warrant. So if you’re stopping a car and you walk up and you smell marijuana in the car, that to me would extend the car. So in other words, now you can’t search the car based on PC if you smell marijuana, right?

Rory Bellina (12:16):
Yeah. You can’t search the car.

Conrad Meyer (12:19):
I mean, I would love to get in law enforcement. I would love to hear from somebody

Rory Bellina (12:22):
About this. Yeah. I would presume it would be an arrest under suspicion of D-U-I-D-W-I under this driving under the influence of marijuana. I presume the officer would just make the arrest based on that. I don’t know. That’s a good question.

Conrad Meyer (12:36):
I don’t know the answer to that. I would love,

Rory Bellina (12:38):
But you’re right. There is no, as far as I’m aware of, besides a hair test, urine blood

Conrad Meyer (12:43):
Test there. And maybe we can find somebody. I hope to find, let’s see if we can somebody on the show for that. I want to find that out.

Rory Bellina (12:47):
And on this topic, I know we’ve talked about this before and I’m sure people are trying to develop, there’s no instantaneous test for marijuana that I’m aware of. Didn’t somebody, I didn’t look it up. There’s the breathalyzer obviously for alcohol that everyone knows,

Conrad Meyer (13:04):
But they have the blood test. I thought they had some kind of test now,

Rory Bellina (13:08):
But what I mean is there’s no field test. If a car is stopped in a traffic violation and they’re suspected of DUI and you think it’s DUI marijuana, how do you test for that?

Conrad Meyer (13:19):
Well, I know there’s levels. In other words, I know the state law and I know the levels, but this says it’s certain amount of THC in your blood, you’re considered impaired.

Rory Bellina (13:27):
But at that point, if you refuse a voluntary blood test, now you’ve got to get, you can’t prove it. You have no proof. You’ve got to get a judge to sign a warrant for your blood to be drawn. Wait for that to be

Conrad Meyer (13:37):
Drawn.

Rory Bellina (13:37):
You’ve got to go to the hospital, get it drawn, wait for it. There’s no instant test.

Conrad Meyer (13:42):
No,

Rory Bellina (13:42):
I mean maybe, I don’t know. Not that I know of. I don’t know of an instant test either.

Conrad Meyer (13:47):
That’s interesting. So wait, we have a whole slew. This is not the only, let me see. This is not the only thing here. Okay, so that’s easy. The other ones are kind of just, I guess they collect fees from individuals who produce medical marijuana to the department of, so basically another revenue source. I mean, I would love to know how much revenue we get from this, how much revenue. I mean, it was kind of like gambling. Remember that long time ago, maybe, I dunno, you might have been young, but the casino licenses, nobody won a casino and then Governor Edwards brought ’em in and now you’re not getting rid of ’em. The casinos are here to stay and they produce a ton of revenue. I would love to know how much revenue medical marijuana produces in Louisiana. I mean, it’s got to be a lot.

Rory Bellina (14:37):
It has to be a lot. Because you have to buy it from to be,

Conrad Meyer (14:41):
There’s only one grower, right? Isn’t it

Rory Bellina (14:42):
LSU

Conrad Meyer (14:43):
Or there’s two.

Rory Bellina (14:44):
Yeah, there’s two growers and then there’s other companies that are I think authorized to be purchased from there. Out of state,

Conrad Meyer (14:51):
You have a grower, right? Then you have what? A distributor. So you have to have ’em separate. And the grower, I think is like LSU, like some university?

Rory Bellina (14:57):
Yeah, LSU in Southern, I think.

Conrad Meyer (14:59):
Right. And then that’s it. That’s the only growers that can happen. That’s it. It’s a university. But then I think there’s some sort of a middleman.

Rory Bellina (15:06):
Yeah, they sell to the biggest one

Conrad Meyer (15:10):
Processors or

Rory Bellina (15:10):
Something. The biggest one that I can think of is Good Day Farms. That’s probably the biggest one. The no name. And

Conrad Meyer (15:16):
Then those people then distribute it to pharmacies.

Rory Bellina (15:20):
Correct. I see. Correct. Yes,

Conrad Meyer (15:21):
That’s

Rory Bellina (15:22):
Correct. So

Conrad Meyer (15:22):
Yes. Interesting. I mean, it’s got to be huge.

Rory Bellina (15:26):
I would think so. And it’s only expanding because I was just looking at the list before we started to get a recommendation. And it’s interesting, one thing I was thinking about before is you’re starting to see the shift in the language from the legislator. This is probably not exciting to talk about, but I’ll talk about anyway. You’re seeing the shift in the language from therapeutic marijuana to medical marijuana.

Conrad Meyer (15:48):
Why is that?

Rory Bellina (15:50):
I don’t know. I don’t know. Therapeutic part of marijuana. Everyone calls it medical marijuana, but for the beginning of time when this started in Louisiana, it was always known as therapeutic marijuana. Now it’s starting to be referenced in all these actions. That’s kind of weird though,

Conrad Meyer (16:03):
Because they’re expanding

Rory Bellina (16:04):
Medical,

Conrad Meyer (16:05):
But they’re expanding it now.

Rory Bellina (16:06):
Well, at first we started with I think two conditions, and then we went up to 14, and then we went up to 16.

Conrad Meyer (16:13):
What are we now?

Rory Bellina (16:14):
Well, the 16th one, or actually the last one was any condition. It was any condition to catch all. Yeah. That authorized clinician in his clinical experience considers debilitating and is qualified. So

Conrad Meyer (16:27):
That’s a catchall.

Rory Bellina (16:27):
The catchall is yes. Yeah, the catchall is just based on

Conrad Meyer (16:31):
Whatever. I could just make it up. Yeah, I think they need it here. Have a script. You know what the funny thing is is I know there’s a ton of older people that take the

Rory Bellina (16:40):
Gummies. Absolutely

Conrad Meyer (16:42):
A ton. And I don’t know if they just do it to go to sleep at night or I dunno what it is.

Rory Bellina (16:46):
I’m sure it helps with sleeping with pain. Therefore, if you don’t want to take Tylenols and aspirin, if you don’t want to take opioids, I think with pain it’s very helpful. Like you mentioned sleeping.

Conrad Meyer (16:57):
I was surprised when I talked to some people in my parents’ generation when I said, do you guys take gummies? They knew exactly what I was talking about. They were like, oh yeah, I got the Delta Z five, I got the beta bomb. I’m like, what the,

Rory Bellina (17:18):
It’s lost. They knew it. Yeah. It’s slowly, not slowly. It’s losing its stigma I think a lot faster than it did. It’s just time.

Conrad Meyer (17:26):
Right. Rory, don’t you think? I mean, I don’t do drugs. I don’t smoke marijuana, don’t do anything. But I mean, when you look at this on paper, I mean it’s like at one point do you say, man, let’s just cut.

Rory Bellina (17:38):
When you look at the effects of marijuana versus alcohol, if you’re having to choose between the two, you would want to choose marijuana at

Conrad Meyer (17:47):
Least. Look, lemme tell you, alcohol is a whole different topic for me. I mean, look, I was alive and I grew up in the age where Louisiana’s alcohol was 18, it was 18 years old. I’ll never forget this. And of course the federal government tried to take the highway funds away from Louisiana.

Rory Bellina (18:04):
So was the mothers against drunk drivers

Conrad Meyer (18:06):
Were mad and all that. I get that. But lemme tell you, if you have the ability to vote at 18, form a company, go to war, drive a tank, a helicopter and kill people.

Rory Bellina (18:17):
Buy cigarettes,

Conrad Meyer (18:18):
Buy cigarettes,

Rory Bellina (18:19):
Lottery tickets,

Conrad Meyer (18:20):
Right? Guess what? You can have a beer. I’m sorry. I get it. I think terrible decision. Terrible decision. Because what all these kids do is go crazy when they go to college and they’ve lived under a state that’s 21 and they’re maybe some overbearing parents. I don’t know. I’m not advocating that, but I’m just saying they go. But same here. The marijuana law. How, at what point do you just say, let’s just cut the red tape.

Rory Bellina (18:47):
So do you think that, and I think we’re going there, I think every state is making their way towards, it’s just going to be completely legalized. Like alcohol is based on age restrictions. But what are the negative consequences of doing that?

Conrad Meyer (19:03):
I mean,

Rory Bellina (19:03):
Besides just the negative consequences of alcohol. I

Conrad Meyer (19:07):
Think it’s the same.

Rory Bellina (19:09):
The concern is that it, it’s going to get in the hands more of minors. It could be abused more. We

Conrad Meyer (19:15):
Can get in hands of minors now.

Rory Bellina (19:16):
I know.

Conrad Meyer (19:17):
I mean, I’ll be honest with you, I think you can’t police everything,

Rory Bellina (19:20):
But it’s a lot harder right now if you want real marijuana from one of these growers that comes through like a distributor like we talked about, you’ve got to get, is

Conrad Meyer (19:31):
It really that hard though?

Rory Bellina (19:32):
Well, you’ve got to make the visit and you’ve got the doctor’s got to verify your information.

Conrad Meyer (19:38):
Then

Rory Bellina (19:38):
You after that and you pay your fee for that. And then after that you have to go to the pharmacy. They again, verify everything. There’s a lot more steps in place to

Conrad Meyer (19:47):
Actually, they’re definitely more steps. I agree with that. But is there really an impediment? I would love to know. Here’s the question. And look, I respect those guys if they want to make the money doing that. Absolutely. I think it’s a great business model right now given the law. But I would love to know of the number of patients that come to you for screening. How many are rejected?

Rory Bellina (20:11):
Yeah. I don’t know.

Conrad Meyer (20:12):
I would say less than 1%. I mean, I would danger. And that’s when you know, just know. That’s what I’m saying is now the time just to cut the tape and just say, you know what guys? This is just some sort of a facade that we put up because we want to feel good about ourselves that we’re trying to protect everybody. But maybe it’s time. Look, I’m just saying, I guess this is a libertarian in me, right? I guess I know

Rory Bellina (20:37):
Free markets. Free

Conrad Meyer (20:38):
Markets, right? But I read this stuff.

Rory Bellina (20:42):
Have you ever seen the receipt from one of these dispensaries out of state? I was looking at one. What

Conrad Meyer (20:47):
Does it look like?

Rory Bellina (20:47):
Years ago? I think it was a dispensary out of

Conrad Meyer (20:50):
Chicago. Is it color coded? Is it based on what you buy?

Rory Bellina (20:52):
It was a receipt based out of Chicago, Illinois.

Conrad Meyer (20:55):
Chicago has medical marijuana.

Rory Bellina (20:57):
I believe it was Chicago. I did not know that. Don’t quote me on that, but I believe it was Chicago. It was somewhere in that area. And I remember when you added up all the taxes and fees, it was over 30%. It was close to 40%. So if you think of that money going into that county or that penny power state, I mean, look at Colorado. I mean, you can’t spend it fast enough because they’re making so much money on it. So I think that is going to be the driving impediment for these more impoverished states, including Louisiana, is that let’s legalize this thing and we’ll tax it at 20% or something high enough to keep the barrier where,

Conrad Meyer (21:38):
And look, I respect our lawmakers and I respect our politicians to a point, but I find that we’re always sort of behind the curve. And what I mean by that is we had an opportunity, several opportunities. Let’s just go back to casino gaming.

Rory Bellina (21:52):
It had to be on the water.

Conrad Meyer (21:53):
Had to be on the water. You had to have a boat. And the thing is, those boats never left the dock.

Rory Bellina (22:00):
No, no. They were just floating. Floating basically concrete to the

Conrad Meyer (22:03):
Floating barges. And so then we gave Mississippi the opportunity to create the Mississippi Gulf Coast. Basically

Rory Bellina (22:08):
Land-based casinos.

Conrad Meyer (22:09):
Land-based casinos.

Rory Bellina (22:10):
We lost that. And now they’re killing it. They’re killing it. They’ve got the casinos, the hotels,

Conrad Meyer (22:15):
People fly into Louisiana to New Orleans, and then they bust ’em over to the Gulf Coast. And for what? We had an opportunity, we lost it. Then the online sports betting, remember that?

Rory Bellina (22:26):
Well, sports gaming, we got that fat. I know we’re off topic, but we

Conrad Meyer (22:30):
Totally off topic. We went in a rabbit

Rory Bellina (22:31):
Hole. Louisiana got sports gaming relatively quick. Mississippi still doesn’t have it.

Conrad Meyer (22:37):
I thought they did.

Rory Bellina (22:38):
No, they do not. Okay. They do not.

Conrad Meyer (22:40):
They have it. I thought they did because people were going to the casinos and doing the sports

Rory Bellina (22:44):
Bet there they have it in the casinos only. They don’t have it through mobile apps. I

Conrad Meyer (22:48):
See.

Rory Bellina (22:48):
So if you want to bet on the Saints game, you have to go to a land-based casino that’s licensed in Mississippi, or you have to be within like

Conrad Meyer (22:58):
A hundred percent. So we’re ahead of the game on that.

Rory Bellina (22:59):
We’re ahead of, because they do not have all the apps that we do where you could bet anytime of day that’s

Conrad Meyer (23:02):
Amazing from your house. But now the same thing with medical marijuana. I thought before I was waiting for to see our lawmakers, were going to look at Colorado and other states and say, look how much revenue’s coming in. I think they’re killing it. And maybe we look at that as an alternative. But I mean, I guess, I don’t know.

Rory Bellina (23:22):
I’m

Conrad Meyer (23:22):
A lawmaker, but I’m seeing all this red tape where we could just simply just do it.

Rory Bellina (23:25):
I think the holdup is that as kind of progressive as we think Louisiana being, especially us being in south Louisiana and the New Orleans metropolitan area, a lot of north Louisiana and northwest Louisiana do not want this. This, they don’t want alcohol. They don’t want alcohol on Sundays. I agree. They think that this is the devil’s lettuce and it’s going to lead to all kinds of problems.

Conrad Meyer (23:49):
I agree. Look, I got friends in the west and I have friends up north. I mean, I’ve got friends all the way up in Minden and all the way up to Shreveport. And I got to tell you, you’re right. I agree with

Rory Bellina (24:00):
You. So I think that as much as we want to enter pushing for it, I think that there’s just as much opposition to this, and I think that this is the middle ground and we are just taking these incremental baby steps. But at some point, the people in Baton Rouge are going to have to figure out what to do with this and capitalize on it.

Conrad Meyer (24:18):
So look, basically now, so basically if you’re out of state, you got a medical license, medical marijuana license, guess what? You can come here and get your cannabis,

Rory Bellina (24:24):
Fill out some paperwork

Conrad Meyer (24:25):
Done

Rory Bellina (24:26):
And get it

Conrad Meyer (24:26):
And done. And then if you’re a nurse practitioner, guess what? You just got your friendship circle expanded greatly

Rory Bellina (24:33):
And your job opportunities are now even better. That’s great. Yeah.

Conrad Meyer (24:36):
That’s wonderful. Well, gee whiz. I mean, I had no idea. Yeah, I really wish, and I hope we do. I hope we get a lawmaker

Rory Bellina (24:45):
Talk about how they practice a law enforcement guy, how their practices have changed now with this expansion. No, that’s a good topic to have.

Conrad Meyer (24:52):
Well, I think that’s good enough for me. Look, I hope everybody that this was a good informative show when we first saw this. I’m like, man, this is great, Rory. I love this topic, and I got to tell you seven bills marijuana governor signed. I mean, I’m just like, we’re moving. It moves at a brisk pace, so who knows what’s going to happen two years from now. It’s

Rory Bellina (25:13):
True.

Conrad Meyer (25:14):
Everyone willing? Thank you so much for being listeners to our show. Please drop us a line or a comment. Give us that five star rating for us, and if you have a topic you want to discuss or you want to follow up with us on anything that we discussed here, send us an email. You’ll have a great day. Enjoy.

Introduction (25:30):
Thanks for listening to this episode of Health Law Talk presented by Chehardy Sherman Williams. Please be sure to subscribe to our channel. Make sure to give us that five star rating and share with your friends. Chehardy Sherman Williams is providing this podcast as a public service. This podcast is for educational purposes only. This podcast does not constitute legal advice, nor does this podcast establish an attorney-client relationship. Reference to any specific product or entity does not count as an endorsement or recommendation by Chehardy Sherman Williams. The views expressed by guests on the show are their own, and their appearance does not imply an endorsement of them or their entity that they represent. Remember, please consult an attorney for your specific legal issues.

Introduction (00:02):
Welcome to Health Law Talk, presented by Chehardy Sherman Williams Health Law. Broken down through expert discussion, real client issues and real life experiences, breaking barriers to understanding complex healthcare issues is our job.

Conrad Meyer (00:23):
All right, so Rory, I got to ask, what happens? Imagine that for a minute. You’re sitting there and you’re a physician and you’re looking at your contract, and in that contract there’s a salary cap and suddenly you’re getting a call from DOJ or an investigator saying that, Hey, by the way, we think that your salary cap is above fair market value and that you’re in violation of a false claim act or in any kickback, what do you do?

Rory Bellina (00:57):
Well, I think we have to go back to where did that number come from? Most of the time, the providers are given a number by their employer and then they’ll go to their attorney or they’ll do it themselves, but they’ll try to negotiate that number. Most of the employment agreements that I see will have in there that caveat that your compensation number is based on what we believe is fair market value, but there’s always that provision in the employment agreement where it can be renegotiated up or down. If the employer or hospital system decides that it’s falling, it’s going too high. So I think the example you’re talking about is that a number is agreed upon, but then after a period of time there’s some sort of audit and they look at it and they say that you’re being compensated too high, or we think that you’re being essentially paid for referrals. Is that accurate?

Conrad Meyer (01:47):
That’s extremely accurate. In fact, I think that actually happened on the North Shore. I mean, that was a North shore, I dunno if you remember the North Shore Hospital, I think it’s gone now, but at some point in time they were paying, and I remember this because I sat and I had several clients that were involved in that, where I found out that their compensation models from that hospital exceeded even M gmas, FMV of over a hundred percent. So they’re getting paid like 110, 120%. And I even questioned, I said, do y’all have FMV valuations from someone to verify that this comp is okay? Oh yeah. And guess what they did? Which was amazing to me. So I knew this was on the radar, and in that case, that’s an easy trigger because there was exceeding fair market value on the comp model. But the normal contracts that I see, same thing with you have that clause in there that says the hospital are usually the system of the employer has the right to adjust compensation should they determine that it could, especially with productivity bonuses and focusing on RVU compensation. And you’re getting beyond what they believe is fair market value, that they have the right to adjust it, which I think is a catch 22, because I mean, nobody wants to work for free.

Rory Bellina (03:10):
Right. And you never want that number to go down.

Conrad Meyer (03:13):
No,

Rory Bellina (03:13):
And I think so much of it, I think a lot of times when you’ll see these audit letters come in where there’s a question about the compensation of a physician is kind of like you said, what is in that physician’s file that led to this compensation and what can justify it? So did the practice just look at MGMA data, which for people that aren’t familiar with that is national survey that’s put out every year. A lot of hospital systems and our firms subscribe to that data and it does a survey across the nation of what compensation looks like based on region specialty type of hospital, private, nonprofit, number of employees. It really gets very granular and some of the data is very good because they have a lot of people respond to the survey, but for some you don’t have a lot of data. And then in certain cases, you’ve got a provider who has a specialty or a subspecialty, and they’re highly trained in experience. And so when you go look at that, what that provider is, let’s say it’s an oncologist, and you look at what that MGMA data is, but then you say, okay, well this physician is double board certified. He’s got a subspecialty in this area, and he has innovated this new procedure that we believe warrants paying 120% of MGMA data. So do you have that information in that physician’s file to back it up? Did you use a third party valuation firm? We have a lot of colleagues that we work with

(04:41):
For these high level physicians because their numbers are typically off the charts compared to MGMA data. So what do you have in that physician’s file to back it up? Or is it something where it’s just blatantly obvious on its face that this is a, we’ll call it a, for lack of better expression, just a regular physician, but that physician is driving so many referrals that we have to find a way to compensate them and we’re going to try to hide it in their compensation for these referrals. I think those are two different scenarios that we can discuss and where the issues lie.

Conrad Meyer (05:21):
Well walk back. I mean, let’s start with the main question. What is fair market value? What is that? I think that that’s the most subjective term, a thousand pound elephant in the room. What is

Rory Bellina (05:34):
It that’s the most subjective term in healthcare? I mean, you’ll see that H-H-S-O-I-G-C-M-S, everyone has different definitions of what fair market value is, but there is no real number. There is no one data set that says fair market value can be found at this website.

Conrad Meyer (05:54):
And see, that’s the problem because almost everything on the regulatory in healthcare hinges on fair

Rory Bellina (05:59):
Market market value

Conrad Meyer (06:01):
Mean. So having that conversation, I bet you if we stuck three valuation firms in this room and said, guys independently, what’s fair market value? Every single one would’ve a different response.

Rory Bellina (06:12):
And they’re probably not going to give you a number. They’re probably going to give you a range and they’re going to have a little

Conrad Meyer (06:17):
Asher or methodology that might be Right. Exactly.

Rory Bellina (06:19):
And there’s going to be an asterisk next to it that says, here’s a range, but

Conrad Meyer (06:23):
Subject to our revision or we have the reserve the right to change it.

Rory Bellina (06:27):
And you have to consider all these other factors of this physician. What does this physician have? If you’re doing a, and I think it goes back to the struggle of these large hospital systems and large employers. They don’t want to do this for every physician.

Conrad Meyer (06:42):
No.

Rory Bellina (06:43):
So if you’ve got a large hospital system that is hiring a group of we’ll call, we’ll say er, ER physicians straight out of residency, they want to look at MGMA data or have a valuation done for what they believe is the fair market value for those, but they don’t want to do it for every time that they’re hiring a physician because that’s just cost prohibitive. It gets very expensive. So they’re using that same information for everyone. It’s not specific to that doctor. And I think that they need to, for your high level high training physicians, there needs to be that specific evaluation done, but it’s just not being done in a lot of cases.

Conrad Meyer (07:25):
Well, also I think about this when it comes to fair market value in terms of a false claims act or some kind of that kind of a suit, it’s whatever the government says they want it to be, right?

Rory Bellina (07:37):
Yeah.

Conrad Meyer (07:38):
So you have a DOJ attorney telling you, well, here’s what we believe FMV is, and that’s it. That’s all.

Rory Bellina (07:43):
That’s what we think it is,

Conrad Meyer (07:44):
Right? This is the, so if they have a number and everybody’s number all over the place, it’s a hard target to hit.

Rory Bellina (07:50):
And then you as the employer have to try to find a way to justify or back into that number, where did you come up with this number? Is it because this doctor is double board certified and has an innovative technique? Or does this doctor drive 90% of referrals to that practice section in your hospital? And how can you really justify that number? And another thing is, are you justifying it now or do you have some sort of record where you justified it before you hired them?

Conrad Meyer (08:23):
Well, here’s another problem though. Okay. So imagine you have a high valued physician going into an employee to start some contracting, a simple contract scenario, right? And in that contract, they have the language that we reserve the right to adjust compensation based on our fair market value.

Rory Bellina (08:38):
Well,

Conrad Meyer (08:38):
Shouldn’t the doctor have the right to challenge that? I mean, shouldn’t a physician have the right to say, okay, show me the valuation. You’re telling me that I’m exceeding fair market value based on your subjective determination. I want some objective values of why that is. I have a right to challenge that

Rory Bellina (08:56):
And from that,

Conrad Meyer (08:57):
And they’ll never let that happen. I have tried that so many times and they will not let me do it,

Rory Bellina (09:02):
And I have never seen it go up. It always will go down, down. They’ll say that according to our analysis, your fair market value has gone.

Conrad Meyer (09:12):
So if I’m the doctor, do I want to be working for free? Absolutely not. So what do you do if you’ve exceeded your targeted, let’s just say, and for those listening, when we’re talking about this, we’re talking about a targeted rvu and you exceed the targeted RV by X numbers, and then suddenly you’re being told, say for example, your target’s a 5,000 rvu and you exceed it by 2000, so you at 2000 extra, and you’re being told that, okay, based on our dollar per RVU times the 2000 extra, you’re exceeding the fair market value and say it’s like September.

Rory Bellina (09:47):
What do you do for the next three

Conrad Meyer (09:48):
Months? What do you do next for the next three months?

Rory Bellina (09:50):
Right?

Conrad Meyer (09:50):
Do you just say, okay, I’m going to go in and just watch tv because essentially that’s what you should do.

Rory Bellina (09:56):
Yeah. Because they’re not going to want to pay you over that fair market value,

Conrad Meyer (09:59):
Right? I mean, you literally would be working for free. I just can’t wrap my head around that.

Rory Bellina (10:04):
No, it’s a problem. Like you said, for the physicians that are on that higher spectrum of knowledge and expertise, and then for the ones that are very productive. Now, what if we flip the scenario where you want to bring in a physician and that their fair market value is let’s say 300,000, but their surgeon and they’re going to refer a ton of lab and imaging work to your center.

Conrad Meyer (10:34):
Do you give ’em a pass?

Rory Bellina (10:37):
I know the answer to this, but can you build into their salary the thought process of, well, yeah, his build services are really only worth 300,000, but he’s going to send every patient for lab work and every patient for imaging and every patient for follow-up on the doctor’s side. That doctor’s going to want to be compensated for that. He knows how much value in a dollar sense he’s bringing to that hospital or that

Conrad Meyer (11:04):
Surgeon. I’m sure the hospital’s going to want to compensate ’em for that. But the problem is how do you do it legally and how do you do it within your regulatory compliance, right? That’s the hard,

Rory Bellina (11:14):
It’s very hard to do. But the Dr. May say, well, I’m not coming to your hospital because,

Conrad Meyer (11:20):
And they have every right to do that

Rory Bellina (11:21):
Because I believe, I know that I’m going to bill X amount of dollars for services, but I’m also going to drive so much more business to your practice. So what do you do in that case?

Conrad Meyer (11:32):
I don’t know. That’s the problem. Let me ask you this. I’m going to sort of pivot there. Most of the time when we’d argue comp for physician contracts, we’re talking about using MGMA benchmarks, right?

Rory Bellina (11:44):
Sure.

Conrad Meyer (11:45):
So what we’re talking about right here at 120% or high level or your lab example, for example, what you just stated. I mean, that’s sort of the outlier. I mean, that is almost the exception to the rule. I think the answer is to your question is that there’s nothing you can do. You have to work in the confines of trying to keep within fair market value. And if that doctor has to walk, guess what they walk. I mean, otherwise you’re just opening yourself up to problems,

Rory Bellina (12:14):
But you don’t want them to walk because you’re losing all those an ancillaries no losing revenue.

Conrad Meyer (12:17):
That’s right. You’re losing revenue from all that. So the only other way to do it, I mean frankly, is you’re talking about medical director agreements. You’re talking about maybe some sort of administrative role where you can compensate ’em for the administrative part separately and try to work in something like that. If you’re a private hospital, you have more options. So you can put them in, if you have a reit for example, you can put them in the REIT for those of you in real estate investment trust. So you have that option. But wait, I want to get back to the normal everyday even specialist contract that we’re looking at. Most times comps are falling at 50% or less from MGMA. And the question I have is, does MGMA itself, is that a reputable FMV? I use it.

Rory Bellina (13:11):
I use it as well. I use it as

Conrad Meyer (13:12):
Well. So

Rory Bellina (13:13):
It’s only not the only source, but it’s the main source that we can rely on because it’s a demonstrative, it’s on paper now. It’s online only, but it’s a demonstrative way for you to say, here’s where these numbers came

Conrad Meyer (13:28):
From,

Rory Bellina (13:29):
And then everything else after that has to be taken on a case by case basis. But you brought up a good point about the medical directorships.

Conrad Meyer (13:35):
That’s a good way. That’s another to thread the needle,

Rory Bellina (13:38):
But the government knows about those and so they know that for my example of the surgeon who’s going to refer a ton of lab work and imaging work, are you just going to go ahead and pay him what you can justify as fair market value and then give him some sort of fake medical directorship where you’re getting him another pot of money? I think the government’s very aware of those situations and they’ll look at those as well. I think that’s why it’s really important for these medical directorship roles that you can actually justify your duties. And a lot of times I’ll see in these medical directorship agreements, they’ll be in there an attachment where the doctor has to state the date and the time and how long he spent and what he did actually being that medical director. Because just giving someone the title of medical director and here’s another $200,000, I don’t think that passes the smell test for the

Conrad Meyer (14:30):
Government’s. A lot of money for a medical director.

Rory Bellina (14:32):
I bet I’ve seen it before.

Conrad Meyer (14:35):
Rare cases. I mean, I had that problem and I was amazed that, I’ll be candid with you, I was amazed the government passed that up. We had that in my kit tam, that whistleblower action, and I had director agreements to your point 200,000 plus, and it was always the highest referral. I brought that up to D oj and you would’ve thought that it was just like, please pass the salt. They didn’t care. I couldn’t believe it. But from our standpoint, when we’re drafting that and we’re advising clients, I 100% agree with you. It has to be fair market value in line, and the administrative duties have to be met, be recorded, otherwise you’re running into problems.

Rory Bellina (15:23):
And we have data. We have MGMA data on medical directorships. Yes, I saw that recently. And what

Conrad Meyer (15:28):
Those 25, $30,000 a year kind of thing, that’s supposed to be 200,000,

Rory Bellina (15:33):
Right? But you and I have both seen those really high ones, and so that’s an

Conrad Meyer (15:38):
Issue. I’m just amazed people would even think that that’s normal.

Rory Bellina (15:43):
Now, what is the physician’s perspective? If they’re involved in, like you said, a false claims act, or there’s a case brought against the physician saying that they’re being paid above our fair market value, and the doctor says, well, wait a second, guys. I went there and interviewed and this is the number they gave me. And I said, okay to it, and I had all my cases in my labs and my imaging there, but I didn’t come up with this number. Is there any defense for the doctor if he had no part in it, meaning if the doctor just took the number that was given to him?

Conrad Meyer (16:16):
I mean, that’s a great defense. Put my hands in my pocket and say, Nope, wasn’t me. They told me. I said I liked it, and that’s it. Sign here.

Rory Bellina (16:29):
I don’t think it absolves the doctor, don’t the water, right? I don’t think it absolves the doctor because the government is going to say, you knew that this was excessive compensation. Of

Conrad Meyer (16:36):
Course, yes.

Rory Bellina (16:36):
Driven to you for you to drive referrals.

Conrad Meyer (16:39):
Well, I guess then we go back to your point about the administrative duties. How much work would you have to put in to objectively state that a $200,000 medical directive fee was legitimate? You follow me? Yeah. Yeah. So if you’ve got a full-time practice and you’re like a 1.0 FTE and you’re doing a full practice clinical whatever years you’re doing and you’re getting paid another two or six figure, just a six figure right of a medical director, you better be damn sure that your calendar entries show significant amount of time administratively or you’re going to be in real trouble. Absolutely.

(17:14):
Because that’s the funny thing. I think doctors don’t realize this, but it’s not just them going to d OJ and saying, they gave it to me. I didn’t realize I just signed the what? The DOJ really not the D oj. It’s the FBI. The FBI is going to come into that office, Rory. They’re going to get the emails, the calendars, the written calendars, the appointment books they’re going to go through and look at the daily, everything of that physician if they’re targeting a clinic or their doctor. I mean, it’s not simply just, Hey, we got a complaint here. I mean, it is a massive, they’re going to come in and take everything and they’re going to take the appointment book and match it with the Outlook calendar on the system. They’re going to look at the time you spent in meeting minutes to see how long you actually were sitting in the meeting.

Rory Bellina (18:03):
Now what about the scenario, and I have seen this before, and I’ve read about this from the publications that the DOJ will put out on their investigations for these.

Conrad Meyer (18:12):
That’s right.

Rory Bellina (18:13):
One was recent where the medical directorship was adjusted in line and this hospital got hit for this, the medical directorship and the compensation was adjusted in line annually based on that physician’s referral patterns. And that was a

Conrad Meyer (18:30):
Real deal,

Rory Bellina (18:31):
And that was a very clear, I’ll have to share it with you. That was a very clear case where this system would look at the doctor’s referrals and then a one year where his referrals weren’t what he probably said he was going to bring, they adjust. It is calmed down.

Conrad Meyer (18:46):
Can I ask the question? Who’s advising these hospitals?

Rory Bellina (18:50):
I think that they’re looking at it from a business decision of this makes sense for business. Do

Conrad Meyer (18:54):
They not contact counsel? I mean, do they not? Again, this to me, this is to cut your nose off to spite your face. I don’t want to pay for it. And then suddenly they run afoul because you’ve got a CEO who’s doing this. That just blows my mind.

Rory Bellina (19:08):
And in every other industry, it makes perfect sense. If you’re not bringing business, then we’re going to adjust your compensation. Not in healthcare. Not in healthcare.

Conrad Meyer (19:17):
Gee whi. So let’s circle back. So just of this, the whole thing is fair market value. How do you figure that out? What do you do if you’re a physician and you get a contract with that cap language, and I guess where do we go from here? How does it

Rory Bellina (19:36):
Work? Well, I think that every physician that’s negotiating their employment agreement and they’re presented with an offer that the employer is stating, here’s your base compensation or here’s your salary, and we believe this is fair market value. I think that provider should always ask, can you show me where these numbers came from? Do you have something? And the hospital system say, well, yes, we checked 2023, now it’s rolling on 2024 data that’s about to come out. We checked 2023 MGMA data and our system pays in this range, and you fall in this range. And that’s where the number came from. I think that that should be step one for a physician to find out from their perspective, are they comfortable with it? Are they comfortable with what is being told to them as fair market value? I think on the hospital side, they should be documenting this.

(20:28):
They should have in there or the employer side, they should have in there their records showing, okay, this is what we offer for this type of physician and here’s where we came to that justification and if we’re bringing in this excellent. The example, I keep using the double board certified surgeon who has this new technique that we’re bringing him in. We believe he’s worth this. They need to go out and get a separate valuation for that physician to justify that. I think that’s the steps that you need to take on depending on what side you’re on.

Conrad Meyer (21:00):
I mean, I also think too that there needs to be a mechanism for a doctor to challenge a systems determination that they’re capped. There’s got to be a way to, because otherwise, I mean, I had the issue of an ortho back spine client of mine, literally to being told that he was capped. It was like August and he had already, he was like a workhorse and he was told, oh, well, we can’t pay you anymore because you’re capped. And that’s just the way it’s going to be. So he would literally go into the office and go watch movies. And I’m like, this is just the most

Rory Bellina (21:43):
Inefficient.

Conrad Meyer (21:46):
So you have a guy who’s clearly got qualifications, who is going in watching movies,

Rory Bellina (21:53):
And then next year

Conrad Meyer (21:54):
They’re not going to pay ’em.

Rory Bellina (21:55):
And then next year for that same physician you just described, are they going to now adjust as RVs down so that he now works 12 months but makes the same amount? Because if I’m the hospital, that’s what I’m probably going to think. I’m going to think, well, let’s just pay him less. We know he is going to work this amount.

Conrad Meyer (22:12):
Let me just tell you. Then he’s going to walk the exit door.

Rory Bellina (22:14):
He’s absolutely going to leave.

Conrad Meyer (22:15):
Yeah, absolutely. 100% going to leave.

Rory Bellina (22:17):
So here’s a hypothetical that we could kind of wrap this up on, but why do you think H-H-S-O-I-G doesn’t put out or have a comparable or say we base our numbers off of MGMA or we’re going to put together our own survey and here is fair market value, it’s going to be updated annually and this is justifiable fair market value. If you have outliers, be sure that you’re able to justify it. Why do you think they’ve never, in the decades that this has been around, they have never done their own? Because this is the hardest question to answer is what is fair market value?

Conrad Meyer (22:51):
I think with the myriad of healthcare contracts and businesses and all of the interactions going on, I don’t think it’s possible to cover all the bases. And of course it’s a moving target because valuation continues to move on a yearly basis. I don’t think it’s set one year and then you late wait three years. But I do think CMS has come out recently with a clarified definition of just fair market value of itself. So I think they’re trying to narrow it down so that this nebulous vague idea of what fair market value could be construed as is sort of narrowed in the sense, but it’s not there yet. I don’t think they’ll ever get there. Maybe they, people put the valuation firms out of business,

Rory Bellina (23:35):
And maybe this is a horrible way to think about it, but maybe they don’t want to say what fair market value is because then it’s going to take away a lot of their power to go after these. If they say what it is, then are they going to have less cases to go after?

Conrad Meyer (23:53):
I see what you’re saying. Yeah. Maybe so. I don’t know. I mean, I don’t know. But you know what, the other way I look at it, that’s great. It is got its good and bad points, good for valuation firms.

Rory Bellina (24:07):
Very good,

Conrad Meyer (24:08):
Very good for them. Hard for clients and doctors to wrap their heads around because this is such a nebulous term with no concrete, truly objective thing. And even if we use MGMA, for example, I think you’re safe if you’re in the bell curve, but when you start pushing the bell curve, and that only happens in the most rare situations, I think, because most systems want to lower the expectations on the base and move the needles. So they always win and make money. But on the rare occasions, you’ve got the unique doctor with the labs, for example, or the expertise or the entrepreneurial, the guy, the gold standard or whatever. You run real close to running across the line. If you push it to the 90th 95th a hundred percentile, even at MGMA.

Rory Bellina (25:02):
I agree.

Conrad Meyer (25:04):
Well, look, lemme tell you this. I like this discussion. I like fair market value discussion, but I want to tell you this. I am putting together a special fraud program so that you and I are going to talk about this. So we’re going to talk about fraud and examining how billions are lost in fraud schemes in healthcare. So that’s going to come up next time. So be on the lookout for that.

Rory Bellina (25:25):
Alright,

Conrad Meyer (25:25):
I’ll lay it out for you and we can tell the audience about the billions and billions of dollars lost in healthcare every year, what DOJ is going to be doing of a forecast of 2025, and sort of our little note to clients as to, Hey, be on the lookout for these schemes and here’s how to protect yourself.

Rory Bellina (25:44):
Alright,

Conrad Meyer (25:44):
Looking forward to it. Alright, have a great weekend. Enjoy.

Introduction (25:50):
Thanks for listening to this episode of Help Law Talk, presented by Chehardy Sherman Williams. Please be sure to subscribe to our channel. Make sure to give us that five star rating and share with your friends. Chehardy Sherman Williams is providing this podcast as a public service. This podcast is for educational purposes only. This podcast does not constitute legal advice, nor does this podcast establish an attorney-client relationship referenced to any specific product or entity does not count as an endorsement or recommendation by Chehardy Sherman Williams. The views expressed by guests on the show are their own, and their appearance does not imply an endorsement of them or their entity that they represent. Remember, please consult an attorney for your specific legal issues.

Introduction (00:01):
Welcome to Health Law Talk, presented by Chehardy Sherman Williams health Law, broken down through expert discussion, real client issues and real life experiences, breaking barriers to understanding complex healthcare issues is our job.

Conrad Meyer (00:23):
So I guess when this is a new extension that we’re looking at here on Medicare telehealth, is that what I’m looking at?

Rory Bellina (00:32):
Yeah, yeah. It came out just a few days ago. I think it was set to expire back in, well now we’re in March, so it was set to expire at the end of this month and everything, not everything, but the majority of what was being extended during the Covid pandemic time has now been extended again. So I’d love to just jump in and talk about what the extensions are and what they mean for different providers. But

Conrad Meyer (00:59):
What happened before though, wasn’t this the COVID-19? I mean, when they amazingly cut through the red tape in a week.

Rory Bellina (01:07):
We’ve talked about that so many times and how much a lot of our providers and us particularly, really liked all of the waivers that they gave during covid because if you remember before, for so many different things, you had to go in person to get these different services or there had to be documentation of in-person visits, some things had to be done, even if it was like a televisit per se. You had to have video, you had to have two-way communications and then Covid hits, and there was kind of a, like you said, cutting the red tape. I think access for patients was really good during that time.

Conrad Meyer (01:50):
I just find it amazing if there’s been no fraud and abuse. If we look at the,

Rory Bellina (01:56):
I’m sure there has. I’m

Conrad Meyer (01:56):
Sure there has been. I haven’t followed it, but I mean, if there’s been no fraud and abuse and this has worked

Rory Bellina (02:00):
Well

Conrad Meyer (02:01):
And now we’re what, five years past covid?

Rory Bellina (02:03):
Five years.

Conrad Meyer (02:04):
Five years?

Rory Bellina (02:05):
Yeah, we just made the five year anniversary.

Conrad Meyer (02:06):
So why are we ruining a good thing? I mean, what’s the basis for this? Why are we going back to the old regime, I guess if it’s worked

Rory Bellina (02:17):
And Yeah, I don’t know the reason for extending these extensions. I think that those are conversations that we’re obviously not a part of. Those are all happening in dc but I think that my speculation is that the government CMS, these different agencies are seeing that it’s working, that these allowances that they’ve put in place have been working really well for patients.

Conrad Meyer (02:42):
Well, it wasn’t just telehealth. I mean, for example, I think I did something recently for remote monitoring I think on that and whether or not you need to be direct or general supervision. And so I think that came into play. But this is interesting because I, I remember a client of mine calling me and saying, oh, this is going to sunset coming up in March.

Rory Bellina (03:06):
Right, right.

Conrad Meyer (03:07):
And what’s the answer to the question? And the answer back just a few months ago was, well, guess what? March it’s going to go away, so we’re going to have to go back to the way it was, and now it looks like we get

Rory Bellina (03:18):
To go through September. Now another, I think we have another six months on these,

Conrad Meyer (03:21):
But why are we doing this? Really? I mean, six months I feel like we just, Hey, let’s do another six months. You know what? Let’s do another six months. Why not just say if it’s not broke,

Rory Bellina (03:31):
Have we, has the government had enough time to say, let’s just make these permanent.

Conrad Meyer (03:36):
Can we doge this? I don’t know. It is so stupid. If it’s working, there’s no fraud and abuse. Everyone likes it. It gives access to patients. Why are we taking it away?

Rory Bellina (03:48):
I think that there is so much politics involved in this on the national level, and my speculation is that with the new Trump administration that’s come in, there was, if you think of when that administration started in the end of January to now, that was really only two months to figure this out, and we’ve got a new director of HHS and then we have a new secretary.

Conrad Meyer (04:11):
Yeah, but do we really think Kennedy knows what this is?

Rory Bellina (04:14):
Well, that was my point. My point is that he’s,

Conrad Meyer (04:17):
You think Robert Kennedy, I like the guy, but do you think he knows what this is?

Rory Bellina (04:23):
That’s my point. You’re stealing my thunder. I make it No, no, no. To do that.

(04:28):
That’s my point is that he’s probably really only been in office for a month and has a ton of homework and things to catch up on, and I think that he and his team and CMS, they have a lot of new people at CMS, they’re having to catch up on, okay, what are these extensions? What was given? What’s working, what’s not working? These were set to sunset this month, March. We don’t have enough time to figure out are we going to let them sunset, so let’s give it another six months. So my speculation is that probably when this sunsets, then maybe this is the time period that they need to work to make these extensions more permanent.

Conrad Meyer (05:09):
Well, if you look, I mean they had something with this telehealth modernization Act of 2024. I guess it died. I mean, I don’t know what happened with that, but that was a permanent fix. But I’ll be honest with you, I haven’t looked at it. I mean it, is it dead? I mean, did it die in committee? I mean, I don’t know, but are we going to see a new push in 2025 for maybe?

Rory Bellina (05:30):
I think that a lot of the big healthcare organizations are going to push to make these things permanent, and now that there’s the new administration in, they’re going to use their connections and their lobbyists to make these things permanent. There just wasn’t enough time to do it between January 20th and now March 21st. So they’re given another six months. But so

Conrad Meyer (05:49):
What does it do? I mean, I know we have a general idea about what it does, but

Rory Bellina (05:53):
I mean, I think overall the thought behind all of this, if we go back to 20, was easier patient access to providers, especially in rural underserved areas. And these extensions are going to continue to allow that like they did during covid. I know one of the big ones was the telehealth services. A lot of times pre covid, we’ll say there were those geographic and site restrictions on if you needed a service or a prescription or whatever it may be through telehealth. You could only be in certain geographic rural restrictions where you just didn’t have access to a provider or your access to a provider was physically so far away that geographic and site restriction was essentially lifted. So you could still get these services, but anyone could get them. You didn’t have to live in such a rural area. And I think that that was a big draw and has continued to be a big draw to get patients access.

Conrad Meyer (06:55):
I can see that. I would like to have to give the patients, I think patients like it.

Rory Bellina (07:01):
Absolutely.

Conrad Meyer (07:01):
I think if you were to poll patients on everything from not just telehealth, but mental health, mental telehealth, having the ability to stay at home and hop on a video call with a provider who is able to provide that in-home care, who doesn’t like that?

Rory Bellina (07:20):
And if you think of the efficiencies that if NAB would’ve been put in place with Zooms, Skypes, Google meets everything that they’ve allowed to be used, as long as it’s secure, you’re now able to see so many more patients. And do you really need a patient driving 30 minutes into the hospital to see their internal medicine provider because they’ve got a sore throat or they’ve got some sort of virus and they need a Z-Pak. Do you really need them to come into the hospital to wait to go through a triage for a check-in, then get put in a waiting room, have the nurse come in and do a set of vitals when most of that, if nothing has changed and the doctor is comfortable with that, they could just do a video visit with you or even audio just in some cases and say, Hey Conrad, what’s going on?

(08:08):
You’ve got a sore throat. You’re congested. Let’s start you on this medication and you’re in and out in five minutes. The patient, it’s great because the patient didn’t have to take off of work, drive in, do that visit, wait through all those steps, leave, get the prescription. Now it’s you do the visit from your home or your office. You say, what’s going on? The doctor scribes it over and on your way home from work, you pick up your medication and no one really misses a beat from the provider side. I think they’ve loved it. I’ve talked to a bunch of providers and a lot of them really, really like these telehealth visits because they still have their in-person visits for things where they need to touch the patient per se. But for these simple things where they could just do it over the phone or over a video call, I think they like it. I think that it streamlines their day. Now, the administration probably of the hospitals loves it. They could fit more patients in and you just have a doctor in his office doing these visits and talking about what’s going on, making the script, and then they could go on and do from a volume perspective, they could do a lot more visits.

Conrad Meyer (09:16):
Well, I think it’s interesting to see the board’s perspective of this and how that has evolved. Because I remember, gosh, I mean what, eight, 10 years ago? I mean, I think you still need a special purpose telemedicine license if you’re out of state, but I think the initial visit had to be an in-person visit, and then the subsequent treatment plan that’s changed, that’s changed.

Rory Bellina (09:42):
The initial visit can now be virtual,

Conrad Meyer (09:43):
Can now be telehealth. Right. And I remember looking at that. I said, man, and that was purposeful. I think that was purposeful because they wanted to keep the home turf and keep the home docs. And I get that. I do. I get it. But I think it shows me the evolution of where the board has looked at technology and patient interaction and has seen the light. But I think still it’s interesting to see, I haven’t seen it yet because I know from talking with the investigator at the board level here in Louisiana, we had a conversation about this. The standard they’re going to hold all these providers to even the special purpose telemedicine license guys out of state is that your initial visit needs to have the same standards as if it was an in-person visit. Okay, now that’s a good point. But my question is how do you do that when you don’t have your blood pressure cuff? You don’t have your scope or otoscope, you don’t have your stethoscopes, you can’t listen. So I think someone needs to have a real conversation in the room saying, well, that’s really not going to happen.

(11:00):
But anyway, but I get it. I like the legislation. I just think that how much time are we wasting? If these measures are really good, why not just make it permanent, cut the red tape like you did in covid? Because I mean, think about that. Think about the amount of time it takes for these bills to get passed and all the comment and the end committee and that committee when Covid hit and this came out, they did it in what? A week? A week. So why do we have all this crazy inefficiencies? So just do it. Just do it.

Rory Bellina (11:38):
I don’t think that the board is going to be,

Conrad Meyer (11:41):
Not the board, but the feds, the feds on CMS side because if they do it, the commercial payers will follow and then the state and their board will follow. So everything, I hate to say it. I mean everything is led by the Fed.

Rory Bellina (11:55):
I think that it would be too complicated, and I don’t know how a federal agency or even a board could come up with a list to say, here’s the things you could do through telemedicine, and here’s the things where you need an in-person. I think that that would take forever to get figured out.

Conrad Meyer (12:13):
No, just let it go. Just open it

Rory Bellina (12:15):
Up. I think ultimately what a lot of the state’s boards do, ours as well, Louisiana as well, is they ultimately say, okay, Dr. Conrad, if you’re saying that you are meeting the same standard virtually, then you would be If the person is in person and you’re comfortable and you’re willing to put your license on the line that you did a visit and you evaluated that patient and all they need is a zpac for their sinus infection. If you’re comfortable with that, then, but if you think for any reason that this person needs to come in to be seen and you can’t write that script through a visit and then scribe it over, then again that’s your call. I think it would be too granular.

Conrad Meyer (12:59):
So put it back in the doctor.

Rory Bellina (13:00):
I think that’s what they’re going to have to do. I don’t think that they Well,

Conrad Meyer (13:03):
I agree with you. I think I totally agree with you. So in other words, it’s more just because we want doctors to have autonomy, then put it back on them and say that if there’s an adverse outcome,

Rory Bellina (13:14):
You have to make the call

Conrad Meyer (13:15):
And you did a telehealth visit, or you’re in the actual visit, you’re on a zoom call or whatever medium you’re using, and you realize that, man, I really might need to see this patient in person. You as the doctor need to make that call.

Rory Bellina (13:31):
That’s your call.

Conrad Meyer (13:31):
That’s your call. And if you don’t do it, then we’re going to fault you.

Rory Bellina (13:35):
I don’t think, yeah, I don’t expect to ever see a list. I’d be really surprised if I would because it would be similar to the

Conrad Meyer (13:42):
I can do

Rory Bellina (13:43):
That. Yeah, it would be similar to the medical marijuana things where it started with a list of, here are the

Conrad Meyer (13:50):
14, how silly that is. Here

Rory Bellina (13:52):
Are the 14. I got to tell you that.

Conrad Meyer (13:53):
That’s so stupid. The whole thing with medical marijuana is stupid.

Rory Bellina (13:56):
Well, that’s going to be another, we got to talk about that another time’s.

Conrad Meyer (13:59):
So should people just pay the $200 and they get their medical marijuana? It’s like getting marijuana, but you have to pay a gatekeeper.

Rory Bellina (14:06):
It’s stupid. But think of how that started. It’s so stupid. Think of how that started in Louisiana. It started with, if you

Conrad Meyer (14:12):
Wanted

Rory Bellina (14:13):
Therapeutic marijuana, there were 14 things you can get it for, and that was it. And then that evolved. Well, now it’s anything that evolved. And they added a catchall, I think it’s number 16 in Louisiana.

Conrad Meyer (14:25):
I don’t even know what that is.

Rory Bellina (14:25):
And it was basically anything that the doctor believes would need it for. Can you do a

Conrad Meyer (14:30):
Telehealth visit to get medical marijuana?

Rory Bellina (14:32):
Yes. Therapeutic marijuana. Are you kidding me? Are serious? Absolutely

Conrad Meyer (14:34):
Serious. I didn’t know that. Yes, absolutely you can. How in the world is anybody? I mean, look, I don’t do drugs in Louisiana, but

Rory Bellina (14:39):
Therapeutic. But

Conrad Meyer (14:40):
Yeah, how in the world is anyone in this entire state who really, if they really wanted a gummy or the whatever, not paying the $200 to get a script, they can do that

Rory Bellina (14:52):
Well in the

Conrad Meyer (14:53):
Like a $200 screening fee or something. I mean, the doctors would make it back on this.

Rory Bellina (14:57):
It’s cash only because you’re not billing insurances for it. Yeah, that’s

Conrad Meyer (15:00):
Correct. And you could do it by telehealth. I mean, you could literally have 50 patients in a day line up and you could Wow.

Rory Bellina (15:07):
But it goes back to the doctor does the visit and says, Conrad, what’s going on? I can’t sleep. I’ve got anxiety. I’ve got back pain. Whatever it may be. The doctor’s comfortable with it. And they write that in Louisiana recommendation. It’s not a script, but they make that recommendation for therapeutic marijuana. Ultimately, if anything goes wrong with that patient, the board’s going to come back and say,

Conrad Meyer (15:34):
I would love to know the pmp. Run the PMPs on the prescriptions by those docs for the medical marijuana to see how many they do a month. It must be staggering. Literally must be out of this world. They have these little clinics, and that’s telehealth. So now you can do it by telehealth if you want.

Rory Bellina (15:56):
Oh my God. Yeah.

Conrad Meyer (15:57):
That’s just amazing to me. So one thing, anyway, I’m getting off. I’m, I’m going over route here.

Rory Bellina (16:03):
Shifting from the benefits that the providers, the physicians have,

Conrad Meyer (16:08):
Well, the patients have the benefit too.

Rory Bellina (16:09):
The patients absolutely have the benefit, but it’s expanded also to ancillary services. So I think those are even harder to do through telemedicine, but it even expands availability for PTs, OTs, speech language pathologist, those could all be done via telehealth.

Conrad Meyer (16:27):
How do you do PT and telehealth? Help me understand that. I get it. I mean, you have to physically be with the patient, right? Pt, ot, I mean, I get it. Maybe to checkup on ’em and say, oh, did you do your leg lifts? I mean, I guess so.

Rory Bellina (16:40):
But

Conrad Meyer (16:41):
I mean, I like convenience. I want it in the home. I like it. I think it’s good. I think it helps people, especially people who might not have the access. Now you’re giving them access. I would just like to see if the fraud and abuse side, in other words, which has been

Rory Bellina (17:03):
Unsurprisingly quiet, that we haven’t seen a lot of OIG. We’ve seen some

Conrad Meyer (17:09):
With telehealth.

Rory Bellina (17:10):
With telehealth, and we see what we find out about the cases that the OIG G publishes, and we see the cases that make a big splash in the news where this practice was seeing 500 patients a day and they were just churning them out. And there’s fraud, waste and abuse in those cases. But I think that for a lot of these, if you’ve got a speech language pathologist and you’ve got a child or an adult who has speech problems and they’re able to do a video call with that patient and that patient is far away and maybe can’t get into the clinic and they’re able to get that same therapy as if they were in person, I think that that seems to work. And that’s been fine. They’re continuing the reimbursement for audio only visits. So again, adding access for a while, it had to be video, it had to be live video to a communication. Some patients don’t have a smartphone, some patients don’t have a computer with a camera

Conrad Meyer (18:10):
Are, wait a minute, wait minute. Are we still calling telehealth audio only phone calls?

Rory Bellina (18:15):
I think

Conrad Meyer (18:17):
The definition of

Rory Bellina (18:18):
Change the phrase telehealth, if you ask 10 people, you’re going to get 10 different definitions on what

Conrad Meyer (18:23):
Telehealth is. No, but I’m talking about in Louisiana for the definition of telehealth, does it include audio only?

Rory Bellina (18:27):
Yes. I did not know that. Yeah.

Conrad Meyer (18:29):
Wow. Okay. I thought that was exempt from that.

Rory Bellina (18:33):
No, there’s audio only allowed services via telehealth.

Conrad Meyer (18:37):
Okay, well lemme throw this out at you. So what happens if I call my doctor and say, look, I need to get a script for whatever, I need a Z-pack because for whatever, blah, blah, blah. Would that be viewed as a telehealth visit or is that just me calling to get another script?

Rory Bellina (19:02):
I don’t know the answer to that.

Conrad Meyer (19:03):
That’s a tough one, isn’t

Rory Bellina (19:04):
It? Yeah,

Conrad Meyer (19:05):
Because I mean, there’s no video.

Rory Bellina (19:06):
There’s no video. But it’s

Conrad Meyer (19:09):
Because before, and I dunno if that changed before that was considered not a telehealth visit.

Rory Bellina (19:15):
Yeah, I’m not sure. I think there’s in

Conrad Meyer (19:18):
That it’s not relevant,

Rory Bellina (19:19):
But I think there’s on, is it a refill versus a new visit and you’re just talking to the doctor on the

Conrad Meyer (19:23):
Phone, but this right here, I think this what we’re talking about, this extension that just got passed from the six month thing, I think get the people in the room that make the decisions to decide are we going to make this permanent or not? Because I think this is just what are we going to do in six months from now? Do another six months.

Rory Bellina (19:45):
I think we’re going to see more permanency in this. I think that right now they just needed more time. Think of the benefit it’s given though to mental health patients that again, didn’t have the time or access to go in for an evaluation or a visit with their psychologist or psychiatrist, and now they can do that from home or from work. I mean, think of how beneficial that’s been. I mean, that’s a big one because those visits aren’t quick. Those are 30, 45 minutes an hour. Now if you can do those virtually and you don’t have to go to the clinic, wait in the waiting room, same thing. Wait to see your psychiatrist, a psychologist for a check-in, and now you could do that virtually. I think that’s great.

Conrad Meyer (20:30):
I

Rory Bellina (20:30):
Think so too. I don’t have any reservations or issues with that. I really don’t. The eligibility criteria that’s been expanded on for what can be done for this, I think has been really good. I think overall it’s been great. What do you

Conrad Meyer (20:51):
Mean by that? I’m excited for it. You mean in other words, more providers coming into the fold for telehealth?

Rory Bellina (20:58):
Yeah, absolutely. I think that when you looked at providers pre covid where they could only see a patient and you had to carve out 30 minutes for them and then you had to build in the waiting time, it clogged up a lot of systems.

Conrad Meyer (21:13):
You mean the inpatients?

Rory Bellina (21:14):
Yes. Now the fact that you could line them up through telehealth visits and they schedule at their convenience, I think that’s been great. I don’t know any providers that have really complained about it.

Conrad Meyer (21:27):
I’m just waiting. I mean, wouldn’t it be interesting to see if technology comes as far Rory as there’s some sort of a certified home health kit, meaning in other words, a blood pressure cuff, not like something you put on that connects to your wifi that when you can go ahead and do the telehealth visit, that the doctor can assess your blood pressure. He can listen to your lungs, he can take your temperature, he can get basic vitals and use that and somehow, so that way if you wanted the kit, you can just order it off of Amazon and it’ll link to your provider. And so that way, that’s got to be happening. Now. I can’t believe we don’t have the ability to, I mean, we have to sure have this so that way. I know that one point, I saw this, they were going to have these mobile stations, telehealth stations

Rory Bellina (22:23):
Where you go in and do those. We

Conrad Meyer (22:25):
Just go in and it was like a booth, like your old phone booth. But then in the booth they got all this whizzbang stuff and you can do telehealth visit in the mall if you

Rory Bellina (22:32):
Wanted.

Conrad Meyer (22:34):
That never took off. I don’t see ’em. Maybe they someplace they did. I don’t know. But I think I agree. I would like to see this become more evolved and I would like to see this become more expanded because I have a feeling that the in-home or the home care model of you wanting to have care in your house is going explode, especially with the boomers. I’m going off a little off topic here, but I’m watching humanoid robots. How is that going to affect long-term healthcare in the long-term home health industry? Right. I mean, so combine that with telehealth and remote visits. I mean, you could technically have everything taken care for you in your house

Rory Bellina (23:25):
Forever.

Conrad Meyer (23:25):
You’ll not need to go to assisted living. You’ll not need to go to a nursing home, if you will. You could stay in your house.

Rory Bellina (23:34):
Right. It’s been surprising for me that we haven’t seen much pushback from the payers and push aside CMS on that because they’re on board with us right now, or they have to be on board. But I haven’t seen pushback from the Blue Crosses, the Aetnas, the Uniteds, Cigna.

Conrad Meyer (23:54):
I’m sure it’s there. I don’t know. We’ve seen, I haven’t seen it. I haven’t asked though, but

Rory Bellina (23:59):
I would even ask. I would’ve thought that if, we’ll say Blue Cross in Louisiana, it’s one of the biggest payers here, one of the biggest non-federal payers here in Louisiana. I haven’t seen real concern or pushback from them on this. Now, it could be because they’re able to now. I mean, they’re paying more for claims because there’s more claims out there because more patients are doing these telehealth visits, but maybe they’re seeing a better return on it. Maybe it’s keeping their patients healthier, so they’re having to pay out less in the long run. Five years is a long time, but we don’t know the long-term effects of all of these visits is the availability of a patient to be able to go in and see a provider and get a prescription for a Z-pack virtually. How does that pay off in the long run from that patient developing something much more serious years down the road where Blue Cross is going to have to pay out a lot more?

(24:59):
Or if you think of the instance of a patient that schedules a telehealth visit and says, Hey, I know I can’t get in to see you in person for six months, but I was able to get this telehealth visit. I’ve got this lump in my neck and I’ve noticed it. It’s gotten bigger. I really don’t know what’s going on, but I just wanted to call and tell you through the telehealth visit that doctor is going to say, let’s go get you in for imaging right away, and then let’s reevaluate if they’re able to catch that tumor or that cancer, whatever it is on a lot earlier stage and not have to pay out oncology claims 5, 10, 15 years later. I think that’s a benefit to the payers. And I think that maybe they’re thinking that getting more access sooner, access quicker and easier access for their beneficiaries, essentially you and I, that they’re looking to see that this is going to save them money in the long run, what they care about

Conrad Meyer (25:52):
Ultimately. Well, I get that. I mean, but you can take that example right there and turning into a diabetic, a pre-diabetic, and you could have life coaches, telehealth, life coaches, telehealth, fitness coaches, dieticians, all those things. And you could even do online shopping now. So you could put everything in telehealth if you wanted to.

Rory Bellina (26:14):
You could

Conrad Meyer (26:14):
And have it monitored in a program that is a comprehensive, I think Blue Cross does this already, and I forgot what they have a name Omega, I think it’s called the name. I don’t know. But I’ve never done it. I’ve never seen it. But I mean, I think you could utilize this. I don’t think it’s going away.

Rory Bellina (26:33):
Not going away. I don’t think It’s not only going away. I think it’s going to get more and more courage. Courage. My wife, for example, recently switched insurances and went from one, I think it was maybe United to Blue Cross or Blue Cross United. I don’t know which way it went, but she got her typical cards that we all get in the mail, but then she got another set of cards, and it was like a third party company. I think it was Teladoc or something like that.

(26:57):
It was encouraging her for simple things. Now these are all doctors that the insurance company has negotiated a race with, but they give you a website and essentially what your account number is. And they say, if you’ve got something simple and you don’t think you need to go to the hospital for it, use our service, use these teladocs that we have, maybe we can catch it earlier. I think it’s saving the insurance company’s money because they’re not having to pay a hospital bill for an inpatient visit to a hospitalist. They’re able to sign you up with one of their teladocs, and it’s a cost savings for them too. So I think that’s another reason why I think the insurance companies are embracing it and why we’re not seeing pushback from them.

Conrad Meyer (27:39):
I’d like to see on the flip end of that, on the other side of the provider side. In other words, are we watching provider revenue decrease because of this? In other words, if you’re not seeing patients and you’re not doing active test, is there ancillary revenue decreasing? I’d like to see. I haven’t analyzed that, but I guess it would be

Rory Bellina (28:00):
Are not, are the providers, make sure I understand the question. Are the providers in the hospitals not making as much money because you’re

Conrad Meyer (28:08):
Now a telehealth,

Rory Bellina (28:09):
You’re doing a visit and it’s a script for a Z-Pak versus you going into the hospital, you’re getting a hospital bill, you’re getting a lab bill,

Conrad Meyer (28:18):
Or just your e and m visit. I mean, can you code a low? I am sure you have to code a lower level e and m visit on a telehealth than you would, and I mean potentially in person on an EM level. So I like to know how that looks on the provider revenue side. I haven’t asked anybody, but I guess you would counter that with the volume.

Rory Bellina (28:39):
That’s what I was going to say. I think that more patients, whatever loss of revenue there is from not getting all of those services, getting that in-person bill, getting that lab bill, I think that is offset by the volume of, yeah, Conrad scheduled a telehealth visit. We did the visit. He complained that he was having a sinus infection. We prescribed him a Z-Pak virtually. It was already at his pharmacy that afternoon. We didn’t make as much money on Conrad during that visit than we would’ve did in 2019 pre covid. However, we were able to see four Conrads in that same amount of time. We were able to see four patients just like Conrad with simple things where we didn’t need all of that in that same period of time. And so I think that the loss of revenue is probably balanced or even outweighed by the more visits you’re able to get in. And I think that that is, and since we’ve shifted and we’re talking about cost now, cost savings, well, we’ve gone

Conrad Meyer (29:48):
All over the place.

Rory Bellina (29:49):
I

Conrad Meyer (29:49):
Get it. I get it.

Rory Bellina (29:50):
But think of the cost savings, Conrad, if you’ve got a doctor sitting in a room like this who’s just knocking out these telehealth visits, think of the hospital cost savings of, you’re not incurring as much front desk staff. You’re not incurring as much MA costs or RN cost to do.

Conrad Meyer (30:08):
Oh, no, I get that. I get that. But what does that, I’m looking at it from the provider eyes. In other words, if I’m a doc and I’m trying to make money and I am used to a certain standard of living, and I’ve gone into this and I’m watching my revenue decrease consistently,

Rory Bellina (30:24):
I don’t know if it’s decreasing.

Conrad Meyer (30:26):
I dunno, answer to that. Think it’s not decreasing. Curious. I’m trying to look it from their

Rory Bellina (30:30):
Eyes. Yeah, I think it’s not decreasing because it’s made up by the volume.

Conrad Meyer (30:34):
I would love to have someone on the show to tell me this. I would love to

Rory Bellina (30:36):
Find out how their practice has

Conrad Meyer (30:38):
Changed. Yes, yes, yes. Maybe we could try to work on that.

Rory Bellina (30:42):
I’ve got some people, I think that would be good. I know some providers, some internists, hospitalists that we could get on to discuss what was your practice like pre covid when your day was lined up with 50 patients and you had to see those 50 patients every six minutes, turn those rooms, get them in and out. Verse now you see a hundred patients. You’re not coding as high of a charge, but you’ve got more of them. Has that really affected your revenue? You can get some people to discuss

Conrad Meyer (31:14):
That. I’d like to see that.

Rory Bellina (31:15):
Yeah. But overall, I was excited to see this. I think our clients are excited to see this.

Conrad Meyer (31:21):
I agree.

Rory Bellina (31:23):
Again, besides the outliers that are defrauding, but that’s going to happen all the time. That’s really nothing New. People that want to find a way to beat the system, they’re going to do it regardless. So I think overall, this is a good extension and I’m excited and hope that it’s put in a permanent place.

Conrad Meyer (31:42):
I think so. I mean, only time will tell. We’ll figure it out. Time will tell. And you know what? Let’s work on getting someone here, because I think honestly, getting someone to tell us the financial impact and maybe, you know what? I can reach out on the payer side. I think I know somebody on the payer side or someone in

Rory Bellina (32:00):
The hospital admin side.

Conrad Meyer (32:02):
That would be really interesting. I want to know, you know what? I really want to know how hospitals, right, and systems have implemented telemedicine within the system, right? I mean, do they have dedicated rooms that docs can use at the facility? Are they letting them do this at the house? I mean, I don’t know, but I’d be very interested to see how hospitals, because most physicians are employed now, so what are the systems doing to embrace telehealth? And we’ll see six months from now, who knows? I don’t know what’s going to happen. Maybe somebody in HHS will say, Hey, this is a smart idea. We’ll continue it permanently. We’ll see

Rory Bellina (32:43):
All. Alright,

Conrad Meyer (32:44):
Until next time,

Rory Bellina (32:44):
Let’s wrap it up.

Conrad Meyer (32:46):
Alright.

Introduction (32:49):
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