Harry Nelson, managing partner at law firm Nelson Hardiman and the author of The United States of Opioids, said the opioid cases are at a “really critical juncture”.
In October, a large case is due to go to trial that combines thousands of claims, mainly from US cities and counties, against 22 opioid manufacturers, distributors and pharmacies. “I think the pressure is rising on the pharmaceuticals to start to move settlements forward,” he said. The plaintiffs are pushing for permission to pursue a master settlement, like the one agreed with tobacco companies in 1998.
This recent settlement is not the first in a series of opioid crisis litigation resolutions. Purdue Pharma agreed to pay $270 Million to the state of Oklahoma in March 2019 and the founding and four former executives of Insys Therapuetics were convicted for opioid racketeering in May 2019.
Attorneys of color are still hugely underrepresented in firms’ upper echelons, but Law360’s 2019 Diversity Snapshot shows that some are going above and beyond to put partners of color in their top ranks.
Among the more than 300 law firms surveyed, attorneys of color represent 16.5% of attorneys overall and about 8.6% of equity partners, less than a percentage point increase from last year’s numbers.
Our ranking grouped firms based on their U.S. attorney headcount in order to compare them with similarly sized firms. The firms on our list are above the average percentage of equity partners of color for their size, and in some cases, they greatly exceed their category’s average.
Diversity is a very important aspect of ensuring an inclusive and collaborative work environment. Nelson Hardiman understands that collective strength is achieved by access to diverse perspectives and therefore seeks to create an environment of mutual respect that values differences, ensures equality and empowers our entire team to succeed.
President Donald J. Trump on June 24 signed an executive order directing executive branch departments to implement policies and rules to improve patient access to information about healthcare costs and quality. The Administration believes that patients need better information “[t]o make fully informed decisions about their healthcare. . . .” The Order envisions consumers using pricing and quality data to compare “shoppable” services—those services offered by a variety of providers—prior to making health care decisions.
Among the specific directives, the Order instructs Health and Human Services (“HHS”) to propose regulations requiring hospitals to publicly post standard charge information, including charges and information based on negotiated rates. Hospitals currently must disclose their prices, referred to as charge description master lists, which show the un-negotiated rates for services. Hospitals generally charge insurance plans and payors less than these rack rates or charges, and these negotiated or discounted prices, often based on complicated proprietary formulas, are typically kept confidential between the parties.
In fact, hospitals and insurers have stated that disclosing negotiated prices could increase costs rather than lowering them since providers could raise prices to match their competitors’ prices. Rick Pollack, President and CEO of the American Hospital Association, released a statement in reaction to the Order that “it’s important to note that hospitals already provide consumers with information on pricing, but publicly posting privately negotiated rates could, in fact, undermine the competitive forces of private market dynamics, and result in increased prices.”
In addition, many providers believe price lists could be misleading as patients typically pay only a portion of negotiated rates out-of-pocket (with insurance paying the rest). The Alliance of Community Health Plans issued a statement in response to the Order that “one size does not fill all for transparency policies. Pricing information is most helpful when tied to an individual’s circumstances, such as benefits, deductibles and copays.”
The Executive Order also directs HHS, the Treasury Department, and the Department of Labor, to propose rules requiring providers, health insurers, and self-insured group health plans to give patients information about expected out-of-pocket care costs. Provider groups have been vocal in their opposition to proposed requirements for providing such estimates as the estimates would be wildly inaccurate in emergency situations, and could not take into account a particular patient’s changing circumstances in their course of care.
In addition, the Order charges the Treasury Department with making changes to regulations related to high-deductible health plan-health savings accounts (“HDHP-HSAs”): (1) expanding patients’ ability to select HDHP-HSAs, (2) increasing the amount that can be carried over from one plan year to the next; and (3) redefining how HSA funds can be used, such that HSAs fund costs associated with direct primary care and health care sharing ministries. Health care sharing ministries are organizations in which health care costs are shared among members with common religious or ethical beliefs. The Executive Order inclusion of HDHP-HSAs is consistent with the Trump Administration’s efforts to expand consumer use of HDHP-HSAs.
The Order also instructs HHS to issue a report on ways to address surprise medical billing. A number of States have enacted laws to prevent surprise medical bills and there are currently a number of bills in Congress seeking to address the issue.
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In shifting the opioid crisis conversation toward solutions, one recurrent obstacle is our binary way of thinking. Healthcare policy, like media coverage, favors “either/or” categorization of all problems and solutions. We love stories with clear heroes and villains. (If you doubt this, follow the coverage of Purdue Pharma, Insys, or other drugmakers these days.) It makes sense that our media is sometimes forced to simplify stories in this way. After all, when things get more complex, viewers tune out. What has been disheartening to me is waking up to the reality that our policy discourse falls into the same trap. This binary approach in actively unhelpful in shaping the discussion of addiction, recovery, and wellness.
The recent history of opioid prescribing is marked by vacillations. As I detail in The United States of Opioids, in the late 1800s, the standard of care for doctors prescribing opioids extended to preventing addicted patients to avoid withdrawal. By the 1920s, the Federal Bureau of Narcotics was arresting doctors by the hundreds for this practice. As the memory of this crackdown faded, the “pain as the vital sign” movement gained steam in the early 2000s. I found myself defending doctors who were being prosecuted by state medical boards for undertreating pain. The pain doctors I advise these days are so afraid of DEA and medical board response that they would rather turn away patients in pain than prescribe more than minuscule doses of opioids.
These swings from one polarity to the other – and back again – have been brutal for patients and providers alike. People in chronic pain are living in misery. In the worst cases, untreated pain is driving an increase in suicides. Rather than contributing to solving the opioid crisis, the binary approach has added another dimension to the crisis. Not only are overdose and substance use disorder rates rising but now doctors cannot treat pain effectively and people in pain cannot get the medications they need. The same dynamic predominates discussions of cannabis and psychedelics. They are the bogeyman to some, and a silver bullet to others. Part of the solution to the crisis is finding a middle ground where doctors can treat pain without fear and people who need medications can actually get them.
The presenters explored the legal and ethical best practices related to contracts and client rights, compensation of marketers, and call centers and lead generation. The goal of the presentation is that the viewer will know how to avoid common compensation pitfalls, such as fraud and abuse, exploitation, inducements, brokering and kickbacks.
Topic: The new anti-kickback laws applicable to the addiction treatment industry and best practices for establishing an effective marketing program that complies with those laws.
“What are ethical compensation practices in healthcare marketing and why are they so important?”
About John Mills
As a Partner and Co-Chair of Nelson Hardiman’s Litigation Practice, John Mills‘ deep knowledge of regulatory compliance lends invaluable insight to his litigation practice. The versatility of John Mills’ healthcare practice and the diversity of his clients provide him with a keen understanding of the unique business objectives and risks facing different segments of the healthcare provider community.
About Ali Beheshti
Ali Beheshti founded Zealie to bring the power of Technology and Automation to the Behavioral Healthcare sector. As the former CEO of a very successful Addiction Treatment Center, he is familiar first hand with all the challenges that come with working with Insurance companies. His mission is to help Behavioral Healthcare providers manage end-to-end patient care efficiently and accurately.
Ending the Opioid Crisis: Harry Nelson Interviewed on Access Hollywood - YouTube
On the program, Harry discussed Lisa Marie Presley’s willingness to open up about addiction and recovery. Lisa Marie wrote the foreword of The United States of Opioids to bring light to the social change that is needed and the high impact shame has on the opioid crisis.
From the foreword:
It is time for us to say goodbye to shame about addiction. We have to stop blaming and judging ourselves and the people around us. We need to do what we can, to use our resources and creativity to overcome this problem. That starts with sharing our stories. It is time that we do so and that we dedicate ourselves to doing what we can to prevent more people from dying, and to support the people around us who are living with addiction.
Where do we go from here? Harry has written a powerful book that is a starting point. The United States of Opioids is a call to action with tangible steps that we can all take. Harry delivers insights into the challenges facing our health system—doctors, hospitals, and addiction treatment providers—and also offers steps that we can all take as parents and with everyone else in our lives. This message is essential and timely. I hope that you will join in the work of taking on the opioid crisis.
The United States of Opioids: A Prescription for Liberating a Nation in Pain, 2019
Founding Partner Harry Nelson‘s recently published article on Forbes sheds light on the politics surrounding the Opioid Crisis. The article discusses the surprising backlash from individuals concerning the issues posed by the United States of Opioids.
Opioid Crisis Politics
Harry describes the messages he receives via social media and how they all seemed to echo similar stories…
• I used opioids prescribed by my doctor responsibly for serious pain that I live with.
• The opioid crisis is about abusers: irresponsible people who took too much and got addicted and/or people using opioids illegally without prescriptions.
• Now my doctors won’t prescribe opioids or pharmacies won’t dispense them because of the abusers—and you are making it worse by conflating responsible users and abusers, stirring the pot, and calling unnecessary attention to the “crisis.”
The trickiest part of tackling the opioid crisis is the millions of Americans currently living in chronic pain who depend on opioids to allow them to have control of their lives. The lack of research on solutions to end the cycle of opioid addiction plays a big part as well. Harry highlights some key points to be focusing on in terms of answers to the problem of the Opioid Crisis.
• Developing condition-specific protocols for the use of opioid medications to create clear standards for doctors to prescribe to people in pain without fear of disciplinary or criminal charges.
As a health-care lawyer, Nelson has had a particularly good perspective on the opioid epidemic that’s decimated the country in the past 20 years. He’s represented drug-treatment programs reeling from patient overdoses, doctors who have prescribed opioids and caused overdoses, those who have refused to provide pills to patients, as well as those who have become addicted to pills themselves.
“I have a reputation for being as close to a mental-health therapist as lawyers get,” the LA-based lawyer told The Post. In “The United States of Opioids,” Nelson guides us through the overwhelming issues and roadblocks that formed the epidemic.
In 2017, there were 49,000 opioid deaths in the US, according to the Centers for Disease Control. Twelve million people in this country are addicted to opioids, and the numbers keep increasing. In 2012 alone, American doctors wrote 259 million opioid prescriptions for pain, enough to provide every single person in the country over the age of 18 with his or her own 30 day supply of painkillers, Nelson writes. If nothing changes, a million Americans will have died from opioid-related causes between 2000 and 2025.
Founding Partner Harry Nelson was recently published in the Daily Journal. The article discusses the impact of the shift from Obamacare to Trumpcare has had on the United States healthcare system. Harry explores the recent developments in the Repeal of the Individual Mandate, Medicaid Expansion, Value-based Care, and insurance coverage rules.
From the article:
Nearly three years ago, my partner Rob Fuller and I offered predictions in our book, “From ObamaCare to TrumpCare: Why You Should Care.” Our goal was to move the discussion around our health care future away from rhetoric and towards reality. We offered a longer-term perspective of the ACA as an attempt to address the problem that Americans pay more for health care than any other advanced industrialized country, and get an inferior product in return, with poor outcomes and gaps in access. We explored the political compromise in the ACA, one that seem to be largely rejected by both sides amidst calls on one side for repeal and replacement and, on the other, for single-payor or universal coverage (“Medicare for all”). We tried to take an honest look at where ACA had addressed systemic failures, where it fell short, and where the jury was still out — and likewise tried to “call balls and strikes” with regard to competing Republican policy initiatives. We took it as a small victory when congressional Democrats and Republicans both shared stories of receiving copies of the book from colleagues across the aisle.
Our effort notwithstanding, the ACA remains a source of confusion today. In assessing recent developments and the issues ahead, it is valuable to differentiate the distinct strands of the law:
(1) the individual mandate, repealed in 2017, that required uninsured Americans buy coverage (with income-based sliding scale subsidies) via insurance exchanges;
(2) the expansion of the Medicaid program to increase access to care for the poorest Americans;
(3) the value-based care initiatives seeking to shift from paying for the quantity of services (“fee for service”) to paying for the quality of health care delivered; and
(4) a series of changes in health care insurance coverage rules, most famously, prohibiting different types of discrimination, such as the denial of insurance coverage based on preexisting conditions.
Harry Nelson, The Shift from Obamacare to Trumpcare, June 6, 2019
Founding Partner Harry Nelson is a top legal expert on opioid crisis response. The American Health Lawyers Association published Harry’s comprehensive look at the SUPPORT (Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment) for Patients and Communities Act, H.R. 6.
The SUPPORT Legislation
The SUPPORT legislation, signed into law on October 24, 2018, was written as a follow-up to the 2016 opioid crisis-focused legislation, CARA (Comprehensive Addiction and Recovery Act). The article, “H.R. 6 and Opioid Crisis Response” provides key takeaways of what hospitals and health systems need to know regarding the opportunities and challenges these new laws pose. A few of these key points include, Jessie’s Law, expanded access to Medication Assisted Treatment (MAT), and increased screening for OUDs.
Like CARA, the SUPPORT Act takes sweeping aim at the opioid crisis, focusing on numerous aspects of opioid prevention, treatment, and recovery, including expansion of opioid use disorder (OUD) treatment access and capacity in residential and inpatient care, medication assisted treatment (MAT), and via telehealth and improving medical education and training resources for health care providers to better address addiction, pain, and the opioid crisis.
The takeaways for hospitals and health systems from H.R. 6 include both important specific requirements and strategic trends in addressing opioid-related activities. Hospitals and health systems should pay particular attention to new regulatory and reimbursement requirements, as well as the evolution in best practices reflected in the SUPPORT Act. This article highlights ten significant directives within H.R. 6 that reflect the emerging consensus on best practices to combat the opioid crisis.