Throughout recent political turmoil health care has been front and center.
The issues, including the Affordable Care Act, mean increased work for lawyers who specialize in the area, advising hospitals, doctors and other health care providers on how to stay in compliance.
Law firms across the country are continuing to expand their health law practices, including Husch Blackwell which now has the seventh largest such practice area in the country. Law schools are also trying to keep up by adding health law programs like the long running program at Saint Louis University that was just cited again as No. 1 in a national ranking.
With changes to federal health care law likely on the way, the health care law industry will continue to boom, experts say.
“I don’t see it tapering off in the near future,” said Curt Chase who leads Husch Blackwell’s Healthcare, Life Sciences & Education team. “I think there’s going to be a constant need for advice and counseling in this area so long as the government continues to be a larger player in the health care space.”
A need for legal services
When Chase started at Husch predecessor Blackwell Sanders in the mid-’90s he was the first attorney the firm had hired out of law school to do health care law. There were three or four other people doing that work, he said, but they had come from other disciplines, like real estate and tax.
At the time, Chase said he never would have guessed the practice would grow to the 120 lawyers it now comprises.
“I’d like to say I had a great crystal ball and picked up the area that was going to boom, but I think it was as much of a fortunate circumstance of picking something I was passionate about and interested in that really started to grow and boom in the legal market,” he said.
Husch’s practice includes lawyers from 12 cities across the country and with paralegals it involves nearly 150 individuals.
The growth has helped Husch move up lists ranking the country’s health care law firms, but it’s not unique to the firm. Law firms across the country are ramping up their health care practices as they see an increased need for lawyers who specialize in the area.
Politics are a driver, Chase said, because the government has been the largest payer of health care services, which means the industry is heavily regulated. And, of course, regulations change as political leadership changes.
“The combination of those forces resulted in an industry under a lot of pressure that therefore necessitates a lot of services, legal, financial, consulting and otherwise,” Chase said.
Even before the Affordable Care Act, Chase said there was “tremendous growth” in the transactional side of health care.
The regulatory side became a focus in the late ’90s and early 2000s when changes were being made to Medicare Laws, and that area continues to grow with the ACA and changes to that policy likely ahead.
“That is really, in my opinion, due to the integration and consolidation that is occurring in many, many segments of the health care industry… a lot of that has come from the Affordable Care Act focus,” he said.
That affects a number of different types of clients, which have also expanded in recent years. Initially, the firm focused mainly on hospitals and physicians, which remains a strong segment of the practice, but it has also grown into other areas like nursing homes and the pharmaceutical area, as well as providers of alternative types of services, like telemedicine, Chase said.
“We’re seeing a lot of nontraditional health care providers needing legal services and a lot of what they’re looking for is lawyers that understand the industry and are keeping up with the industry,” he said.
More and more clients are looking for attorneys with a real understanding of health care that includes specific areas of the industry. Sandberg Phoenix & von Gontard, for instance, recently added a lawyer who focuses primarily on the Health Insurance Portability and Accountability Act.
That expertise could be helpful to many clients, such as small doctor’s offices that don’t have the internal infrastructure to build robust HIPAA policy and need a quality risk assessment to make sure all the right measures are in place to protect patient privacy, said Jeff Dunn, who leads the health care services practice group.
Sandberg can now provide a lawyer to go on site, do a risk assessment and let an office know where potential weak spots exist. Sandberg hopes to build that service into a flat fee legal product that the firm can provide to its health care clients, Dunn said.
“That’s something new and innovative we were doing.” Dunn said, noting that many clients are feeling pressure to keep costs down. “We’re trying to partner with them on that effort, this is one way we can do that internally.”
Like Husch, Dunn said Sandberg has seen its health practice grow dramatically in recent years – Dunn started at the firm in 2001 and said the practice has doubled in that time, now up to 36 lawyers.
The growth also expanded the type of work done by the firm, which traditionally focused on litigation. Sandberg has increased its regulatory team to meet the demand for risk management and regulatory and consolidation advice.
With an uncertain future for health care regulations, it seems certain that clients are going to continue to need legal advice in the foreseeable future.
“I don’t see that need really reducing until we have some stability from the national health care landscape,” Dunn said.
Increasing group of students
With health care law in the political spotlight, more law students will likely choose to enter health law programs, said Rob Gatter, co-director of the Center for Health Law Studies at SLU.
SLU’s center, which was officially established in 1982 but has roots dating back to the 1970s, is one of the earliest such programs in the country. Last week, it was named the best in the nation by U.S. News & World Report for the 13th year in a row.
Gatter attributes the program’s strength to SLU’s overall focus on service learning, which has students learn by doing instead of from a textbook. In a disability law class, for example, students are looking at St. Louis laws and where they come up short. A health care finance class will look at proposed regulations and students are encouraged to write comments to regulators about the proposals.
“That is the DNA of the university, of the law school, it’s not surprising that it is the DNA of the health law program,” Gatter said. “I think that really sustains it.”
Competition for the program continues to grow as more and more law schools are adding health law programs. Gatter said he believes more than half of the law schools in the country now have such programs, including big names like Harvard and Yale that added programs in recent years.
“At this point I don’t think any of the top 100 law schools doesn’t have a full time professor whose primary aspect of teaching and writing is health care law,” he said.
The real growth, he said, has been jobs. When he graduated from law school in 1990, Gatter said the options to practice health law were primarily with the government or working on malpractice claims. Now, students are routinely hired into the private sector for entry level jobs.
Part of that is because growth in federal regulations has meant the idea of complying with the regulations is a full-time job, and increasingly organizations are wanting a compliance officer with a JD. Plus, health care organizations keep consolidating and becoming larger entities.
“It makes more and more sense for those organizations to have in-house counsel,” he said.