This episode features a conversation with Ren茅 Jovel, Assistant General Counsel at Versiti Blood Health, Inc. In this discussion, Ren茅 reflects on growing up in Los Angeles, California, attending Northwestern University for undergrad and Marquette University School of Law. Ren茅 details his career progression from working in a state senator鈥檚 office as a constituent services representative, to joining Goodwill Industries of Southeastern Wisconsin as an in-house attorney and transitioning to his current role as assistant general counsel at Versiti. During the conversation, Ren茅 emphasizes the importance of mental health, adaptability, and authenticity in legal careers. He also provides advice to law students and early-career professionals regarding the importance of seeking support and embracing the unknown, while pursuing a path that align with their interests and well-being.

搁别苍茅鈥檚&苍产蝉辫;笔谤辞蹿颈濒别:

• Title: Assistant General Counsel
• Company: Versiti Blood Health, Inc.
• City: Milwaukee, WI
• Hometown: Los Angeles, CA
• College: Northwestern University
• Law School: Marquette University School of Law

Click here for full list of The Path & The Practice episodes.

You can also find, and subscribe, to this podcast on all major podcast platforms including , ,  and .

In this episode, Jana Kolarik, a partner in 麻豆传媒鈥檚 Health Care Practice Group and Angie Caldwell, Principal and CFO of PYA, discuss the importance of work relative value units (WRVUs) and fair market value (FMV) under the Stark Law and what this can mean for how health care organizations pay their physicians.

For more information regarding the 鈥淟et鈥檚 Talk Compliance鈥� podcast series, please click here.

Please note that the interview copy below is not verbatim. We do our best to provide you with a summary of what is covered during the show. Thank you for your consideration, and enjoy the show!

Jana Kolarik

Hello and welcome to the Let’s Talk Compliance podcast series of Health Care Law Today, presented by 麻豆传媒 & Lardner and PYA. I’m your co-host, Jana Kolarik, a partner in 麻豆传媒’s health care practice group.

Angie Caldwell

And I’m your other co-host, Angie Caldwell, principal with PYA. We are excited to have you join us today. Before we begin our show, we want to remind you to subscribe to Health Care Law Today on your preferred podcast app. Please visit healthcarelawtoday.com or pyapc.com. For today’s show, Jana and I will be discussing some potentially problematic provider compensation topics.

I am excited to be podcasting with you today, Jana.

Jana Kolarik

Me too, Angie. So I think our first topic today is we’re going to talk through maybe work relative value units (wRVU) and productivity models. I think this has been a topic that you and I have spent a lot of time discussing. And I think just as a beginning structure issue, thinking through this particular issue with the lens from my perspective as a lawyer, thinking through personally performed services under the Federal Physicians Self-Referral Law, commonly known as Stark Law, and also sort of thinking through fair market value (FMV), which we’ll talk about as FMV under Stark as well. But also thinking through that personally performed aspect of WRVUs will kind of be peppered through this and is affected not only from a Stark perspective, but a kickback perspective. I mean, you and I have spoken about this in multiple different ways.

The concept as we were talking through this before the podcast of not all [w]RVUs are created equally was something that just struck me, frankly, people’s understanding and, frankly, physicians’ understanding of what work RVUs are, I think is important because it’s a component of how they are being paid by payers. And it’s again, also this component of how they’re being paid through their practices or through health systems.

But let’s talk a little bit about what we’ve seen as far as issues with inaccurate or inconsistent determinations of wRVUs. Do you want to kick us off on some things that you found and then let’s just talk through them?

Angie Caldwell

Absolutely. So if you think about the prevalence of the productivity model as a compensation model type, probably 70% of hospital employed physicians are on a productivity-based compensation model. So it is very important then to ensure that the input to the compensation model surrounding work RVUs is correct and accurate. So what most often happens when measuring the work RVUs is around ensuring that the work RVUs are modifier-adjusted and personally performed.

Systems have limitations. No system is entirely perfect, but what we’ve seen happen in several instances is a system might not be able to compute or handle modifiers. A system between the billing system and the provider compensation system, the modifiers might be dropped out of the calculus. There are many, many things that can happen related to computing those work RVUs. So it is incredibly important to ensure that they are correct.

Jana Kolarik

Right. And I think some of this is, so when we talk about modifier adjustment, those modifiers are present in the billing itself. So they’re there in how it’s billed with the Current Procedural Terminology (CPT) code. And sometimes there’s, I don’t know, a misunderstanding about whether or not to keep them or leave them off when it comes to the physician compensation. So obviously the modifier adjustments are reducing, in many cases, the wRVUs that are then attributed (or the work RVUs that are being attributed) not only from a billing context, but also from a compensation context. So by leaving them off, essentially you’re attributing more WRVUs, which is then attributing more compensation from a productivity perspective to that physician.

So thinking through the modifier adjustment issue and the systems issue that you’ve encountered, systems are obviously the best situation. So if it’s calculated through a system, through an electronic health record (EHR), through something that is not touched by human hands, it could be more accurate. But how do you verify or touch up against when you come into it, a new client, whether or not their wRVU calculations are accurate? How do you figure that out?

Angie Caldwell

Sure. And I know you and I have talked about effective compliance programs and compliance audits, and this is one of those areas that the compliance team or even the internal audit team can help an organization ensure that the work RVU computations are accurate and that the modifiers are included within that calculation. To the extent that they are not, and it does happen, then on the other end, accommodations/mitigations need to be made within the compensation plan design to ensure that the overstatement of work RVUs in one part of the mathematical formula is offset by a reduction in the compensation per work RVU in the other side of the formula so that the overall compensation then doesn’t run afoul of FMV and the applicable regulations.

One of the things here that I think often gets misunderstood/overlooked or even perhaps becomes a complication is that the multiple payment procedure reduction, of course, that is a modifier, but many payers, because of the sophistication of the billing systems and the way that the information transmits between the hospital and payer, that modifier is often not even required to be billed compliantly. And so the payer knows that a multiple procedure has been done, but perhaps the modifier has been left off internally for compensation purposes. And that’s one that frankly can have a significant impact on a work RVU determination.

But it is important, again, within the compensation design to ensure that what we are measuring from a work RVU perspective is as accurate as possible and includes all modifiers, including the multiple procedure payment reduction modifier.

Jana Kolarik

Yeah, that makes a lot of sense. To me, there’s two buckets here. There’s the systems accuracy, and then there’s the compliance overlay related to the accuracy of the data. So is your system spitting out data that is accurate with regard to the modifier inclusion, as you’ve just mentioned? And then is the base CPT or coding that’s present for that particular physician accurate based on compliance audits? So let’s touch on that really quickly, just because it can affect it. And I think sometimes is overlooked and thought of separately when it should be thought of as a combined issue.

So if you have a healthy compliance program and a healthy auditing function within that compliance program that is testing the billing and coding of claims, we’ve talked about individuals coding their own claims, belief that the work provided was very high and that the medical decision making was very complex and coding things at higher levels – level fives – which can spin off higher wRVUs. But if you have a coding and documentation expert come into that information and looking strictly at what the documentation can support, it’s possible that the coder can say, “Look, it’s not a level five, it’s a lower level code.”

So ensuring that that documentation is correct, which then documentation is reflective of what has been coded and billed is important because it then affects not only sort of accurate billing and coding, which is important from a payer perspective and from a overpayment rule perspective and False Claims Act (FCA) perspective, but is then important from a compensation perspective. And I think frequently, if you have an issue with your coding documentation, your error rates, that disconnect sometimes will happen without realizing how it is affecting physician compensation until somebody like you comes along, Angie, and those questions are asked and really pushed on to make sure that if there is a productivity model that takes into account wRVUs, are those true and accurate wRVUs?

Angie Caldwell

The old adage garbage in, garbage out.

And it really does start with the documentation in the record from which that bill is then coded and that CPT and modifier is then attached. Not every service is going to be a level five service. And that’s where effective compliance programs can help. An easy test is to compare the physician coding frequency to a normal frequency from Centers for Medicare & Medicaid Services (CMS). So CMS will show you the frequency of the CPT code by physician specialty. Comparing that frequency, comparing that bell curve from a standard bell curve to the physician in question is a really easy way to see if that billing is perhaps off. And if it is, if the bell curve is completely to the right showing all level fives and very few {level} ones, then it’s an opportunity to ask more questions and find out exactly what’s going on. But that is the first step in ensuring that the compensation model then doesn’t get awry as a result of that incorrect billing or perhaps coding irregularities that may happen.

Jana Kolarik

Absolutely. And so let’s talk a little bit about other things that may affect what is being attributed to a physician as a wRVU. So we’ve had, there’s a distinct difference between billing and what’s being attributed to a physician under their national provider identifier (NPI) from a billing context and what is considered to have been personally performed by that physician. So what comes into play there is something that you want, which is collaboration between physicians and advanced practice practitioners (APPs), including physician assistants and nurse practitioners. So in the incident to context, in the global surgery package context, in the split shared situation, you have things that may have been billed under the physician’s NPI that may have been worked by an APP.

So as you’re looking at a particular physician, and I think you and I have talked quite a bit about surgical specialties and the use of APPs and when they’re used and how they’re used, how do you take that into account when you’re trying to discern whether or not the wRVUs that are being attributed to a particular physician or physician’s NPI are truly worked or performed by that? Does that make a difference in kind of your assessment?

Angie Caldwell

It sure does. And what we’re trying to get to from evaluation perspective, of course, is measuring the physician’s personally performed work effort. The work RVUs and the way that the billing is designed may not always capture only personally performed work effort. For example, in the split shared billing that you spoke of, or perhaps in a global surgical package situation.

So first, it’s always important when collecting the population of work RVUs to apply to the compensation model is to start with work RVUs that are rendered by the physician. So most billing systems will show you the codes by a rendering provider or billing provider. First capture it by rendering provider which will strip out all of the incident-to services that are not personally performed by the physician. Then it’s a matter of assessing the use of the APP and frankly, how the physician uses the advanced practice provider. Are they using them as an extender to do those post-surgical examinations? How are they using them? Or does the APP have a separate and complete patient panel from the physician? It’s important to know how the physician is using the APP.

In those instances where the physician is using the APP as an extender, it’s then important to understand that the way the billing system works is different from how the personally performed service is being determined because the APP is part of some of those codes. And those global surgical packages, the APP’s work is part of that CPT code. So understanding that-

Jana Kolarik

Pre and post.

Angie Caldwell

Yes. And understanding that and understanding how that impacts physician compensation is important. And most often from a valuation perspective, some consideration is made either in assessing and valuing the compensation per work RVU (the conversion factor), or within looking at the total value of the work RVUs attributed to the physician themselves. So in other words, some discount is likely applied to one or the other to ensure that the compensation ultimately results in FMV and to really assess what the physician is personally performing.

Jana Kolarik

Yeah, makes a ton of sense. Talk to me about, because we’ve talked about this from time to time, a wRVU for everything. So I’m sure that that statement sends a thrill of just pain through you. But the belief that under a wRVU model or a component that if you’re performing a service, there should be some type of wRVU for that service that I’m performing, even if it’s not something that’s a true wRVU that’s been calculated, that’s been set up through the CPT and through WRVUs through CMS. So talk to me about what that looks like and some of the questions that have come up about that and what is maybe a more effective way to deal with that situation than really creating a wRVU for everything.

Angie Caldwell

Yeah. And you and I have had some conversations about this, about how work RVUs as part of the total value of the CPT code, it’s truly a reimbursement methodology and initially was not intended to be how physicians were paid and compensated. Because the work RVU, again, it’s easy to measure, it’s consistently measured, it’s agnostic as to payer, and so it has become a great measure of physician work effort. {However we} know that it was not intended to be the one and only way to compensate a physician, there is a desire by the industry to make everything a work RVU because it is consistently measured, consistently applied, agnostic into payer, all of those wonderful things, but it doesn’t always work.

So translating administrative services into work RVUs, for example, within a compensation model, in my opinion, I’ve seen that be a very dangerous approach simply because the risk and the value of that clinical and administrative time is so different. Proxy work RVUs for clinical services where perhaps CMS has not provided a work RVU value, those are other areas where I can get behind a proxy work RVU in some instances for clinical services, but there are others where it just simply does not make sense and perhaps a collections-based or a per-encounter-based compensation methodology would make more sense and frankly be easier administratively.

Jana Kolarik

Yeah, 100%. And you and I have sort of fixed modeling that dealt with that latter issue, so a 100%. So let’s talk a little bit, I want to talk a little bit about specialties and wRVU compensation models. And I’d like to talk a little bit also after that about the mismatch of compensation and productivity. So in looking at wRVU compensation models, you and I have had multiple discussions over the years related to why is that specialty or why are we trying to shoehorn a hospital-based specialty into wRVU compensation model?

So let’s talk a little bit about where that makes sense to say no, to say, let’s try this a different way because it doesn’t make sense in this particular context. So context of hospital-based physicians, can you talk to me a little bit about compensation modeling that makes more sense just based on kind of flow of patients and control of schedule, those types of things and sort of in that context?

Angie Caldwell

So if we think about hospital-based physicians, they are 鈥渃atchers.鈥� The universe is in control of who arrives in the emergency room that day, how many patients are on the floor, and how many patients are in the intensive care unit (ICU) unit. They are catchers and not immediately responsible, if you will, for driving the procedures, the visits, and the encounters. There’s so many other things at play for that hospital-based physician. So a productivity model then makes a lot of sense when the patient is in … Or I’m sorry, when the physician is in – control of that schedule, the number of procedures, the number – by reputation -the number of patients that are coming to them, all of those things, it makes a lot of sense.

In a hospital-based setting, it starts to make a little bit less sense simply because we talked a minute ago about not everything is a level five. So a physician in a more of a coverage type role, coverage, meaning coverage of the floor, coverage of the emergency department (ED), coverage of the ICU, again, if their compensation model is based upon productivity, then they are incentivized, just because of the way their compensation model is designed, to drive work RVUs. And that perhaps puts the incentive to making more level fives when there aren’t level fives. So it makes more sense in those hospital-based settings to have more of a coverage type, a shift-based model, and then perhaps consider some productivity incentive for surge times or other high volume times.

Jana Kolarik

Yeah, makes sense. And to that point, and to underline the point that you’re making as well, if you do have those types of productivity components for those particular types of specialties, then again, not the billing compliance is ever unimportant, but it makes it all the more important if you have, especially if you have physicians in some way coding their own work, to have that double check and that audit over it, just to make sure that that billing is tight and accurate.

Angie Caldwell

Absolutely. And a word on, I know you and I have talked frequently about when is a productivity incentive appropriate for a hospital-based specialty. And there are times. It’s a compensation design – it does get tricky – it’s a compensation design skill that needs to be carefully and thoughtfully applied. But the base for the physicians working in these hospital-based specialties should be the normal, the value of that base compensation should be based upon the normal environment, the normal flow, the normal census, the normal number of visits, and then understanding that that’s going to fluctuate up or down, but rewarding the physician. No one intends to create a compensation model that doesn’t reward the physician for their skill and hard work. So recognizing when perhaps a surge incentive or a productivity incentive is warranted is a good thing to add to a compensation plan.

And that could be, again, carefully designed so that you know when that surge is actually occurring within a unit. And it doesn’t even have to be based upon work RVUs and a traditional work RVUs times conversion factor kind of methodology. It could be based upon some kind of another incentive, an engagement incentive, or another incentive that’s valued a different way. So there are ways to accomplish it without the productivity being the main calculus of the compensation plan.

Jana Kolarik

Yeah, that makes total sense. And I do believe, and you and I have talked about this as well, there is kind of, I don’t know, this general pressure or belief among physicians that the productivity method of compensation is in some ways better than other ways. And I just want to say on this podcast that is not accurate, and I welcome your thoughts on that as well, because I do think there’s the pressure, internal pressure from physicians who should be paid the value of their work, and as you said, for their expertise, et cetera. But that pressure to believe that the WRVU methodology is in some way better than the others is something that just needs to be debunked. Thoughts on that?

Angie Caldwell

Absolutely. I’m with you. It’s not always the best model. I think it gets back to – it’s easy. It’s something to understand this times this equals that. And I think there’s a notion that the shift value or the salary value will be somehow be deflated because it’s not represented by the physician’s ({work RVU} work effort, but showing them and demonstrating to them that the compensation is fair, it’s FMV, it’s based upon the services provided, is important to help debunk that.

Jana Kolarik

Yeah. Fair. Thank you. So let’s talk a little bit about the mismatch of compensation and productivity and the belief and again, we’ve talked about this before, but there still is this clinging to the 75th percentile, this belief that that is really the amount that physicians in some way should be paid. And what does that look like though, this is the issue, when the productivity is not at the 75th percentile? And how do you deal with situations or how do you, as a valuation expert, deal with situations where you’re trying to educate your clients as to why the 75th percentile may not work with somebody who may is at the 25th percentile, they’re at the end of their career or they are just slower or less productive than others? How do you deal with those conversations? How do you explain that?

Angie Caldwell

Yes. And so it gets back to, number one, the myth that anything at lower than the 75th percentile is FMV. So number one, that’s just simply not true. But there are instances where the methodologies for determining FMV within an organization are based upon that threshold, that 75th percentile threshold, and nothing else.

Effective thresholds have more than one level of test, whether that be compensation per work RVU, whether it be a difference in the productivity level and the compensation level. Normally it’s a combination of those to determine if a physician’s compensation is within the range of FMV. In that testing and in determining the differential between productivity and compensation for a physician, there could be very good reasons as to why someone is compensated at the 75th, but producing at the 25th.

And I’ll give you a few of those reasons. So one is someone in a rural setting. So if you think about someone, a provider in a rural setting who may not have the volume simply because the population does not support volume for that physician, but that physician is needed desperately in a community. So to get the physician to that community to provide the service, sometimes 75th percentile compensation or more is required to provide them to the community to provide that service, but they will not have, likely, the productivity to support that level of compensation.

So again, understanding the facts and circumstances around that difference between productivity level and compensation level is extremely important.

Jana Kolarik

Yeah. So then it comes to the … And I think about this and the thing that strikes me as you’re going through the example, I think having folks internally at your practice, at your health system, at your hospital to evaluate compensation and then go out to valuation experts circumstantially. So let us rely on several different resources from a survey perspective. And then being able to know the point in time when it makes sense to then go to somebody like you to say, do we have enough behind this? We’re paying at the 75th, but their wRVUs or their productivity is much lower than that. Is there support for paying them at this level?

I mean, when you talk to clients about having those triggers in place for evaluation of compensation for their physicians, how do you talk to them about making sure that they’re careful in that analysis and when that trigger is frankly sprung for you to be brought in? How do you talk to folks about that? Because what you don’t want to obviously have happen is to not have a rule situation or not have an exception to this rule and have physicians paid at the 75th percentile, but producing at the 25th and not have the rationale around how that is still FMV for that particular physician. Talk to me about triggers.

Angie Caldwell

It is a very important conversation right now and one that PYA has advised on a lot lately because I think in the past, historically, the thought was is that every FMV opinion had to be generated by a third party valuator. And that’s simply not true. So much valuation work can be done internally by the organization created by, and that valuation work can be done through work of a compensation committee through an effective compliance program, and together then creating those thresholds that the organization can use to assess and determine a compensation valuation before sending something outside.

And so setting those parameters again, it’s organization-dependent, it’s going to be dependent upon an organization’s risk tolerance as to what they’re able to handle as an organization. And it’s going to be based upon, again, their location, their geography, their population. So we work with several organizations that have small urban facilities, but then they have very rural facilities in their system. And navigating the dynamics from an internal valuation threshold perspective of the two becomes complex. Having that active compliance program, having that active physician compensation governance committee is really important. And having more than one threshold, I think is also very important because just because it’s over the 75th doesn’t mean it’s not FMV, but being under the 75th doesn’t mean that it is. And so having multiple thresholds allows you to internally to better assess where your physicians are.

Jana Kolarik

Yeah, that makes total sense. I think that this has been a fantastic conversation just to key people into these issues with regard to these wRVU or productivity models and things that people should be thinking about. We’ll talk in another podcast about things that we can do and that we would recommend that folks do to add on to what you just said at the end of this conversation. What structures can you put in place? What are best practices with regard to compliance in this space? And I think that’ll be a nice second podcast in this series.

But I welcome final thoughts from you, Angie, on this. I mean, I think wRVU methodology, as you had mentioned, from my perspective, is something that is all over and that has come into spaces and specialties where it may not fit ideally, so has created issues from that. And from my perspective as well, the billing and coding and documentation issues can impact the compensation as can the use of physician extenders/APPs. So there’s a bunch of things in there from my perspective as a health care lawyer and from a compliance perspective that we can look at and be thoughtful about and work compliance around.

But from your perspective, what are the takeaways that you want to leave people with with regard to this particular topic?

Angie Caldwell

Absolutely. If your primary method of paying physicians is on a work RVU productivity basis, it’s imperative that the calculation process surrounding those work RVUs is excellent. It must be excellent. Notice I didn’t say perfect. I don’t know that any calculation process is going to be perfect, but it does need to be excellent to ensure that the overall compensation plan doesn’t run afoul of FMV.

Jana Kolarik

Yeah. Thank you. This has been a great conversation. Really always appreciate your thoughts and the discussion on these topics and hope that our listeners find it equally as instructive and helpful. Thank you.

Angie Caldwell

Thank you. Thank you, Jana.

Jana Kolarik

We want to thank our listeners for joining our Let’s Talk Compliance podcast series with Health Care Law Today, your connection to timely legal updates in the health care and life sciences industry. We encourage you to subscribe to this podcast and be sure to be on the lookout for part two of this series. Visit 麻豆传媒’s Health Care Law Today blog at healthcarelawtoday.com and pyapc.com. If you like the show, don’t forget to subscribe and be sure to rate us five stars. Until next time, I’m Jana Kolarik of 麻豆传媒 & Lardner.

Angie Caldwell

And I’m Angie Caldwell at PYA. Thanks for listening.

This episode features a conversation with Chanley Howell. Chanley is a partner and intellectual property lawyer in 麻豆传媒鈥檚 Jacksonville office where his practice focuses on a broad range of technology law matters. In this discussion, he reflects on growing up in Jacksonville, FL, attending Vanderbilt University for undergrad and the University of Florida College of Law.聽Chanley shares his path to law school, including how his father being a lawyer influenced his decision to become an attorney. And, he details the different types of work that fall under the technology transactions, cybersecurity, and privacy umbrella at 麻豆传媒. He also discusses the importance of law students becoming A.I. literate and how the adoption of A.I. is impacting the practice of law. Finally, Chanley provides advice on the importance of finding a firm with a culture that most aligns with who you are.

颁丑补苍濒别测鈥檚听笔谤辞蹿颈濒别:

• Title: Partner
• 麻豆传媒 Office: Jacksonville
• Practice Area: Tech Transactions, Cybersecurity, and Privacy
• Hometown: Jacksonville, FL
• College: Vanderbilt University
• Law School: University of Florida College of Law

Click here for full list of The Path & The Practice episodes.

You can also find, and subscribe, to this podcast on all major podcast platforms including , ,  and .

This episode features a conversation with Jesse Neil. Jesse is a healthcare attorney in 麻豆传媒鈥檚 Nashville office. In this discussion, he reflects on growing-up in Nashville, TN, attending the University of North Carolina at Chapel Hill for undergrad and the University of Mississippi School of Law. Jesse shares his personal journey, including working as an assistant attorney general and spending nearly a decade in-house before transitioning to law firm life where he established a unique practice area at the intersection of public policy and healthcare operations. Jesse also discusses why he decided to lateral to 麻豆传媒 shortly after the firm opened the Nashville office. Finally, Jesse provides advice on the importance of keeping an open mind about your career path.

闯别蝉蝉别鈥檚&苍产蝉辫;笔谤辞蹿颈濒别:

• Title: Partner
• 麻豆传媒 Office: Nashville
• Practice Area: Healthcare
• Hometown: Nashville, TN
• College: The University of North Carolina at Chapel Hill
• Law School: University of Mississippi School of Law

Click here for full list of The Path & The Practice episodes.

You can also find, and subscribe, to this podcast on all major podcast platforms including , ,  and .

This episode features a conversation with Joseph Dowdy. Joe is a litigator and the managing partner of 麻豆传媒鈥檚 Raleigh office. In this discussion, he reflects on growing up on farm in Powells Point, NC, attending the University of North Carolina at Chapel Hill for undergrad and the University of North Carolina School of Law. Joe details his legal journey, including the pivotal years he spent serving as a judicial law clerk for the North Carolina Court of Appeals, as well as the path, and insights, he鈥檚 gained on his journey to becoming a trial lawyer. Additionally, he discusses his decision to lateral to 麻豆传媒 from another large law firm. Finally, Joe provides advice on the importance of allowing yourself to be human.

闯辞别鈥檚&苍产蝉辫;笔谤辞蹿颈濒别:

• Title: Partner
• 麻豆传媒 Office: Raleigh
• Practice Area: Litigation
• Hometown: Powells Point, NC
• College: The University of North Carolina at Chapel Hill
• Law School: University of North Carolina School of Law

Click here for full list of The Path & The Practice episodes.

You can also find, and subscribe, to this podcast on all major podcast platforms including , ,  and .

This episode features a conversation with Casey Knapp. Casey is a partner in 麻豆传媒鈥檚 executive compensation and employee benefits group. She is also vice chair of the firm鈥檚 Business Law Department and chair of the firm鈥檚 Best Self Committee. In this discussion, she reflects on growing up in Mequon, WI, earning her undergraduate degree from Sweet Briar College and subsequently attending Washington and Lee University School of Law. Casey details why she decided to become an employee benefits and executive compensation attorney, including pivoting her practice as a senior counsel. Additionally, she reflects on her path to leadership at 麻豆传媒, and her role as a department vice chair and chair of the Best Self Committee. Finally, Casey provides advice on the importance of embracing the unique growth opportunities that arise from unexpected hardship.  

颁补蝉别测鈥檚&苍产蝉辫;笔谤辞蹿颈濒别:

Title: Partner

麻豆传媒 Office: Milwaukee

Practice Area: Employee Benefits & Executive Comp

Hometown: Mequon, WI

College: Sweet Briar College

Law School: Washington and Lee University School of Law

Click here for full list of The Path & The Practice episodes.

You can also find, and subscribe, to this podcast on all major podcast platforms including , ,  and .

In this episode, Lauren Carboni, co-chair of 麻豆传媒鈥檚 Health Care Litigation Area of Focus, is joined by Chanda Hinton, Founder and Executive Director of The Chanda Center for Health, a pioneering nonprofit dedicated to empowering individuals with long-term physical disabilities. This episode highlights the significance of The Chander Center for Health for the long-term physically disabled community. They will discuss the Center鈥檚 bold advocacy efforts to make integrative and collaborative services accessible to those with long-term disabilities and to make disability competency the new standard in health care.

For more information regarding the 鈥淟et鈥檚 Talk Compliance鈥� podcast series, please click here.

Please note that the interview copy below is not verbatim. We do our best to provide you with a summary of what is covered during the show. Thank you for your consideration, and enjoy the show!

Judy Waltz

Hello and welcome to the Health Care Law Today podcast presented by 麻豆传媒 & Lardner. Each episode we’re joined by a different thought leader to discuss current legal trends in the health care and life sciences industry. I’m your host, Judy Waltz, partner and chair of 麻豆传媒’s Health Care Practice Group. We’re excited to have you joining us today. Before we begin our show, I want to remind you to subscribe to Health Care Law Today, either on iTunes or your preferred podcast app. Please visit our website at healthcarelawtoday.com. On today’s episode, Lauren Carboni, co-chair of 麻豆传媒’s Health Care Litigation Area of Focus is joined by Chanda Hinton, founder and executive director of the Chanda Center for Health, a pioneering nonprofit dedicated to empowering individuals with long-term physical disabilities. This episode highlights the significance of the Chanda Center for Health for the long-term physically disabled community. They will discuss the center’s bold advocacy efforts to make integrative and collaborative services accessible to those with long-term disabilities and to make disability competency the new standard in health care. Take it away, Lauren.

Lauren Carboni

Thanks so much, Judy. My name’s Lauren Carboni. I am a senior counsel with 麻豆传媒 & Lardner based in our Denver office. I’m also the co-chair of our Health Care Litigation Area Focus. I sit in our health care group and my practice is pretty diverse. I’m a regulatory and compliance attorney, and I also work with clients to respond to government enforcement actions and internal investigations dealing with a variety of issues, reimbursement, false claims act, you name it. So, on today’s episode, I’m speaking with Chanda Hinton, who is the founder and development director of the Chanda Center for Health. The Chanda Center for Health is a pioneering organization that’s redefining wellness through person-centered collaborative care, and they predominantly serve individuals with long-term physical disabilities. The center’s located in Lakewood, Colorado and offers a holistic approach that adapts to each participant’s evolving health care needs, ensuring that care is not only effective, but deeply meaningful.

The center really provides a sense of community for their participants in addition to all the medical needs and ancillary services that these individuals need. So under one roof, the center provides a wide range of on-site services including acupuncture, massage, chiropractic care, adaptive yoga, behavioral health, physical therapy, and primary care. These services are accessible through a variety of payment options such as Medicaid, worker’s compensation, private pay, and discount programs. Another really neat feature of the center is for individuals who are eligible that live more than 30 miles away from the center and can’t get there. There are remote services available in partnership with Palco, so participants can get acupuncture, massage, and chiropractic treatments away from the center as well, which is really neat.

And additionally, the center collaborates with Craig Hospital to provide free inpatient massage and acupuncture sessions to individuals who are recovering from spinal cord and brain injuries. For those who don’t know Craig Hospital, which Chanda can talk about this too, but Craig Hospital is an incredible resource, an incredible hospital based in Denver that provides care to individuals who have experienced spinal cord and brain injuries. So whether onsite or remote, the Chanda Center for Health is committed to empowering individuals with physical disabilities to live healthier and more independent lives. Now that I’ve teed that up, Chanda, I would love to introduce you. Please tell me a little bit about yourself.

Chanda Hinton

Hi, I’m so happy to be here. I’m Chanda Hinton, founder and senior development director over at the Chanda Center. As you had said, I am just really happy to be here to talk about all the various things within health care that are occurring in so many different directions regarding what we do at the Chanda Center, but some of the system pieces that live beyond us and how it truly just impacts our day-to-day impact on our participants. A little bit about myself is I have been in the position founder of this organization for the last 20 years, and it has stemmed from a personal experience that I went through that I’m sure you and I will touch base on, and just being able to take a personal situation and research and then advocate and deliver services for something that I felt was critical for the long-term physical disability community.

But quite frankly, essential and life-saving and definitely a portion of health care that I believe is often overlooked for all of us, not just those with disabilities, but is definitely a model of care that we shouldn’t embrace altogether just for so many different components of cost savings, of improved quality of life, of wanting to be social and engaging in the world, which that’s what humanity is all about. So I’m just really excited to be here and I’m excited to talk about all the things that this podcast can bring up that are just essential to understanding and discussing when it comes to this topic.

Lauren Carboni

Thanks, Chanda. I’m really excited about our conversation today. I think you and I have known each other now for, I want to say probably 10 years, which is crazy to me. And what you’ve built at the center is absolutely incredible. I had the opportunity to go to the center multiple times, and in my opinion, this is how health care should be delivered. It is accessible to everyone, and it’s just a welcoming, incredible place. I would love to hear the catalyst for why you founded the Chanda Center. I would love to hear your story if you’re comfortable sharing, but I really do think that without you, Chanda, this center would not have happened. And I mean, you were just such a force of nature, and I really want everyone to know why the center is there now and it starts with you.

Chanda Hinton

No, I appreciate that and I’m happy to share the details of that. So when I was nine years old, I accidentally was shot in the back of the neck, and so the bullet 22 rifle severed my spinal cord between C5 and C6. And so I was really just thrown into the medical model, and I do think that as humanity were always going to have some sort of connection with the health care system because we’re human. We’re going to have things that will go bad with our health from various times. And so with that being said, unfortunately mine was a little bit more catastrophic. And so I spent a good amount of time in rehab right after I was injured, and then I was sent home just like, “Chanda, here’s your power wheelchair, and here’s all the medications that you need to take as a result of your spinal cord injury. And these are secondary conditions and these will require this medication.”

And that was in ’91, so being semi, my mom, myself and my family, a bit naive about how do you really handle a spinal cord injury when you’re also in a rural community? What’s right? What’s wrong? You put your trust in your providers and your physicians. And so I just basically sat in my wheelchair from when I was nine until 21. I couldn’t get coverage for ongoing physical therapy for the rest of my life. I couldn’t get other types of services that my body probably at the time I didn’t know needed, but definitely needed. And so what happened is when I turned 21, I started having chronic pain. And so I go to the physician and they’re like, “Oh, yeah, that’s another secondary condition. Chronic pain comes with this particular situation.” And so this was right in 2003 during the peak of the opioid epidemic.

And so it was like, “Oh yeah, here’s some Percocet.” And so I got addicted to Percocet not knowing, so very unknowingly, but I became bed bound. I was 59 pounds. I wasn’t able to eat. So then what was really interesting is that I used the medical model when I was nine to save my life, but then I over utilized the medical model, which then landed me in severe acute care where I was basically failure to thrive. And so they saved my life again. And in that moment is where all of this really shifted and changed. And so when they saved my life, the physician who I had known since I was nine years old looked at myself and my family and was just like, “What’s the next step?” And that’s when my sister who had been studying yoga for a very, very long time, just spoke up and said, “Why aren’t we looking at things that are more proactive and more preventative and less invasive and less side effects like medication, those types of things that Chanda’s body deserves? Because before she was shot…”

I mean, I was very active. I was mobile, I was running around, I was healthy, I was never sick. “And so why aren’t we giving some of the things to her body that deserves such as movement and these various other components?” And we were like, “So what does that look like?” And again, we’re coming from a rural community. She was like, “Well, let’s talk about acupuncture and massage and chiropractic and ongoing physical therapy.” And, of course, we were open to the idea. And then there was also some other system pieces that made it like, “Well, yeah, that’s great. I can pay for all of that out of pocket and I will, especially if it’s going to keep me sustained and wellness, but what does that look like long term and financially, right-

Chanda Hinton

… if it did work?” But I went ahead and I tried it, and I always tell people, so Lauren, I’m talking to you. And as you mentioned, the center that we’ve created, the reason I’m talking to you is because integrative health care, integrative medicine literally saved my life. And from that moment, I was like, “This can’t be this way. This is so bizarre. Why are we keeping people sick, which is costing us more money? It’s causing even more complex issues.” I would call 911 probably every other day because my pain was so severe. I was in the ER all the time. And so it’s like it adds up. Cost is a lot, but yet, ever since I started the acupuncture, massage and chiropractic and actually moving my body, stopped calling 911, stopped going to the ER, stopped all those things. And Lauren, you’ll have to let me know when you kind of want me, because my first thing I knew right away was to research because I was like, “One, I need to research. I want to find out, is this just about me? Two…”

And when I found out it wasn’t about me, I was like, “Oh my goodness, this is not just my story. It’s so many people’s story within this long-term support, long-term disability community.” But I called up my Medicaid at the time and I just said, “Hey, you’ve been spending a lot of money on me, which feels more like reactive care, and I just have been participating in these really great services that are saving a lot of money, and I’m curious what can I swap out to get this versus this?” And the lady on the phone, she just said, “Oh, we don’t fund those things.” And I’m in my 20s, so I’m like, “Well, let me talk to your supervisor.” And that’s when she was like, “Well, it’s a legislative decision.” And so that’s where the light bulb went off.

And so from there, which we can get into in some other conversations, but from there, that was the catalyst. it was one my illness and finding the integrative therapies, but the second piece was actually feeling well enough and on fire to then learn that it wasn’t just me and that there was a way to change it. That’s what really sparked the fire even further to the point where I’m like, “All right, well, let’s go change some legislation and let’s get this covered and let’s really then look about how do we become a health clinic that can really do some deeper work in that area.”

Lauren Carboni

Yeah, absolutely. Thank you for sharing your story, Chanda, you’re truly inspiring. And it’s incredible that you took something that happened to you and figured out a way to feel better and wanted to share that with others and did it and are doing it. Let’s talk about the legislative piece first, and correct me if I’m wrong, but that’s what started, you went to the state, to Medicaid and advocated to get Medicaid to start covering these integrative services, and then the center came second, right?

Chanda Hinton

Yes. Yes. It wasn’t the kind of order that I anticipated because we were like, “Okay, let’s start a nonprofit.” We needed to start raising money for people to get these services now, because we didn’t know how legislative or systemic change can take a while. It could be plenty of no鈥檚 before there’s a yes, right? And so we came forward with approaching it at two angles as a nonprofit. The first was let’s raise money now so we can at least get some people getting the services while we also address the primary issue with Medicaid, covering it for the sake of cost-effectiveness, improved quality of life, all those pieces. So, I’m raising money simultaneously and changing legislation. And so yeah, the biggest components about running that legislation in Colorado was that I had some very specific ways that we approached it.

So I wanted to approach it from a consumer directed. So I didn’t really rally any providers in those spaces. I didn’t go to any of the associations that represent acupuncture, massage, and chiropractic, because I really wanted the legislators to hear that this is really coming from your constituents. This is really coming from Medicaid recipients who live with long-term disabilities and they know their health and they know what they need, and therefore, let’s drive that narrative and that movement through us and not providers. We always thought that it could make our legislators also just assume it’s another population of providers that are just trying to make money or whatever, but…

Lauren Carboni

Right, or another avenue for reimbursement?

Chanda Hinton

Yeah. But again, how many people are knocking on the door to become a Medicaid provider either, right?

Lauren Carboni

True, very true.

Chanda Hinton

So there’s those components to it. And then so we drove it that way, and we just simply just said to them, it’s like, “We are asking for you to do this as a pilot. We want it to be a waiver. We want to prove to you and show to you that it’s cost-effective.” And I know, and we even said, “We know that that’s what you guys care most about is the dollars. And then secondarily, you’re going to see a more vibrant community of those that you serve. Because if you have healthier folks on Medicaid and they become employed and now they get onto a Medicaid program where they’re now paying back Medicaid to be their insurance company, it’s kind of a win-win.” And so there was a lot of those discussions and we even mentioned that let’s do it small and then we can grow it later.

And that we recommended having an independent evaluator. So then that way, it wasn’t just very anecdotical, but that it was very much an independent evaluator could look at the claims cost for those that were doing it in various other things. So in 2009, we got it passed, and it still exists today. We’ve actually expanded it. It’s now the entire state of Colorado, and it represents a very diverse group of folks living with long-term support services, long-term disabilities with various neurological lack of mobility needs, and they can access acupuncture, massage and chiropractic under a pretty significant amount of units per year. And so we were excited to get that done. And then obviously as soon as that was done, there were some other things that came up that made us need to really identify like, “Well, a health center’s probably going to be the next step.”

Lauren Carboni

Yeah. So you’re referring to, it was originally called the Spinal Cord Injury Waiver, correct? That was what was passed in 2009?

Chanda Hinton

Yes. So it was spinal cord injury in 2009. It was around for 10 years in that particular kind of pilot, very restricted. And then when we renewed it in 2021, basically, that’s when we expanded it statewide to say, spinal cord, MS, CP, spina bifida, brain injury. But we also changed the name of it. I convinced our lobbyist who do pro bono work for us and some other folks that, “Could we please name a waiver that’s not named after a disability?” So we changed it to the complementary and integrative health waiver.

Lauren Carboni

Got it. And so it’s now the complementary and an integrative health waiver, CIH waiver., it was renewed and expanded statewide for those, I think it’s adults, who are 18 years old and have certain diagnoses including spinal cord injury, multiple sclerosis, brain injury, muscular dystrophy, and cerebral palsy. How long is the CIH waiver in effect for? Is it another 10 years?

Chanda Hinton

Well, it’ll be ongoing. Every other waiver in every state Medicaid programs, you have to renew them every five years. And that’s just an internal thing that the Colorado Health Care and Financing, the health department here in Colorado will just have to submit something to Centers for Medicare & Medicaid Services (CMS). But we don’t have to run legislation to do that unless there is any sort of budget issue to where the department might reach out and say, “Hey, you need to get your advocates rounded up just because when we’re in a crunchy time with the budget, they may be looking at things such as your waiver and other things to cut. And you all as advocates need to be aware of that.” But it should be just in

Lauren Carboni

Perpetuity.

Chanda Hinton

Yeah, there we go. So basically it’s like that in the sense of it should just be ongoing and there shouldn’t be any really more effort around the legislative side of it.

Lauren Carboni

Got it. That makes sense. Do you have a sense of how many Coloradans are able to utilize that waiver?

Chanda Hinton

It is extremely significant. It is right now… I mean, for me, I think it’s been a significant number. I think there was around a 30,000 individuals that were eligible for this waiver. That amount is not on the waiver right now because what we have also been struggling with is that the systems with Medicaid, since we passed the bill in 2009, there’s just been redesigning of the systems when it comes to the case management. There’s been internal system changes around how you submit claims and how the process of enrolling. So all of those systems changes every time. And quite frankly, sometimes the turnover in case management within the Medicaid systems oftentimes will allow for education that should be consistent and ongoing rather than one time, which I also believe the department’s trying to get better at. But it feels as though we keep having to really educate, educate, educate, because we will get case managers that have been at places for very long periods of time that still don’t know about the waiver.

And it’s, to some extent, really blows our mind. And so we as an entity in collaboration with the Department of Medicaid are working diligently to make sure that it gets pushed out there, that everybody’s aware of it, even primary care physicians should be aware of it for long-term support service populations. Because oftentimes, physicians don’t even recommend these services because they don’t even know about this waiver that exists that could help their patient with chronic pain. And so it’s like, we’re really trying to dial that in. And again, that can take time, that can take years just to get a message across, especially when it can be a lifesaver for a lot of folks.

Lauren Carboni

Yeah, absolutely. Yeah, that is definitely something important in trying to figure out how to get the message out. And hopefully, there’s other partners. I imagine Craig Hospital is probably one that is a good partner to try and get that message out.. I want to hear more about the center, now that I have an idea of how the waiver got in place, your role, the center’s role in getting the waiver in place. Let’s talk about the center itself. What year did the Chanda Center for Health open? And what services do you provide? Tell us about your participants. I want to hear it all.

Chanda Hinton

Yeah, absolutely. So we opened in 2017, the building itself, the Chanda Center where we’re at today. We were still doing direct services prior to that, but it was definitely in smaller spaces, not as much space for the ability for what is occurring today, which I’ll share with you, couldn’t really happen. And so we’re really excited about the fact that we were able to go from smaller spaces from when we first started to where we are today. And there’s a few reasons why we decided to become a Medicaid provider of that waiver, because typically at first, it felt very self-serving. Most people don’t create legislation, pass it and then be like, “Oh, yay, now I can benefit from that revenue.” So what happened is that when it occurred, there were not providers signing up. That was our first effort, was to get the word out there to let providers know that, “Hey, now there’s a new waiver. If you’re an acupuncturist, massage therapist, please sign up. Please start serving this population that is in much need of your services.”

And what happened is most individuals did not want to sign up as a Medicaid provider. And I could see that in the massage and chiropractic and acupuncture world, typically, some of these practitioners may only have a very small self-employed little clinic. You know what I mean? Where some of them may have larger ones. And so that became the first hurdle. And so with that being said, we came together as an entity, our board of directors and our staff, and just had the conversation about, “Well, what if we became a provider?” And the other component that we were also hearing is that for some of those that maybe wanted to enroll, they were also saying that, “Well, I don’t know much about folks with long-term disabilities. If they come into my office, how am I supposed to transfer them out of their wheelchair onto a treatment table? I feel like there was a lot of providers having… And for very good reason, maybe being scared of just not wanting to hurt anyone.

And at the same time, just not being exposed enough to realizing that there’s a lot of accommodations that they would have to do because this is a complex population. So not only in addition to becoming a provider of the waiver, we also wanted to take on that challenge of like, “Yeah, this population is who we love the most. we want our participants to come into this building and feel like they belong.” And I will say that right now, I mean, on an average day, I think that, and this could be very… I’m a very optimistic, so this is a very pessimistic view for work, but I feel like on an average day, about 80% of people will often feel like they do not belong in the world with their disability because there are so many barriers that happen day to day just from going to the grocery store to going to running errands and not automatic doors, all these things just within the public.

But for me, I was like, “It should never feel that way when you’re trying to access health care.” And that was what we wanted to do at the Chanda Center. So here at the Chanda Center when we opened, we’re a 6,000 square foot facility and all underneath one roof, we provide acupuncture, massage, chiropractic, physical therapy, care coordination, behavioral health, and primary care services. So that means all of our individuals, and that’s covered by Medicaid and Medicare. So the individuals that come into our building can access all of those services because we cater to that population because that population has had to unfortunately rely on those government programs. With that also said, the reason why we love having all of those services underneath one route is because it helps people with their transportation.

It helps people to not drive around the city to go see different providers, but it also, we’re meeting their needs in terms of accessibility. And so when they show up, there’s lots of wheelchair accessible parking, auto doors. When you come in, there’s a front desk that is not high, you actually get to check in and look at the reception in the eyes and say, “Hey, this is who I am.” And they will transfer you onto treatment tables. If your urine bag is full, everybody in the building knows how to empty a urine bag. There’s no stigma, there’s no weirdness. It’s just we’re so much about embracing health care and disability in this building. It just feels completely natural.

Lauren Carboni

It’s incredible, Chanda. I mean, this is how health care should be delivered. Health care should be accessible to everyone, every provider office should be set up so those in wheelchairs feel welcomed and that the providers are trained, or have disability competency training and know how to treat everybody. It’s just, I can’t echo enough how incredible the center is with what you’re doing, and I really want it to be a model for health care everywhere.

Chanda Hinton

Oh, I do too, Lauren, I appreciate you saying that because I think that our community struggles because we’re really trying to educate the health care community that unfortunately we need all of us to step up. And I always tell people that when you step up and you know how to care for people with disabilities well, it makes it so much easier for you to care for every walk of life, because when you can get complexity, all the rest is easy. And I always tell the folks that maybe are in the health care systems that maybe can’t make those bigger decisions. It’s like when you do advocate internally, or if you’re a private practice and you make the choice to do it, you’re advocating for your own self. Just know that your ability is temporary. We all ageIf you look at the stats, either you get a temporary injury in your life, people get long-term injuries, and then you’re aging.

So we’re all going to land in the need for accessible health care at some point, but for some reason that it remains out of sight, out of mind for people until they get there. But then once they’re there, nothing has been changed because there wasn’t enough people that wanted to change it prior, before you got there. So yeah, for us, it’s very much a heartfelt mission and we love our everyday work because we know that we’re meeting a critical need and we’re impacting people’s lives. And I think that we just hope that the other health care systems and models pick up on it because I think it’s essential to vitality and cost-effectiveness.

Lauren Carboni

Yeah, I agree. I guess, how can providers and medical professionals incorporate disability competency into their practices? Does the Chanda Center, do you provide education to providers who are interested in being able to provide accessible health care to everyone?

Chanda Hinton

Absolutely, Lauren, we have an online curriculum that we built specifically for physicians after we built it. We got, again, very little response because I think that one other component to this is when it comes to regulatory and other components of compliance for being a Medicaid or a Medicare provider, is that there’s really not a body that enforces these requirements. And so providers oftentimes will see that curriculum and some of them will love it, but I would say a majority of them have expressed to us like, “Well, I don’t serve people with disabilities So it’s very interesting But if you’re a Medicaid, Medicare provider, you should be educated on how to, and so the thing is that we keep that curriculum available because we do believe that there are those that want to impact people’s lives. We know that physicians have gone to become of an MD or NP or whatever because they wanted to help people.

Unfortunately, sometimes they get caught up in the systems about what can be covered, not covered. How much time can I spend with a patient? So I think that we do have it, this educational platform that we’ve built for that very purpose, and we want people to take it because it also shows you that you can spend zero money to be disability competent, and you can spend a little money and then you can spend a lot of money. So with that being said, we should all be doing it. But yes, we do educate providers, and it’s just a portal that we do online. We’ve also gone into places and assessed… Let’s say they’re building a new clinic and they want us to assess the accessibility, and we’ll go in and do an assessment for them just to be like, “Well, all of these things are great. Yeah, you’ve covered it by the code, but it’s not really accessible.”

Lauren Carboni

Right. Right. I mean, you made a good point. There are federal and state laws and regulations that do require businesses and providers to have accessibility to health care, but when it comes down to who’s enforcing that, it’s really challenging to figure that out. I mean, the laws are convoluted and it’s kind of a puzzle to figure out what exactly you need to comply with. But then if there’s a provider who’s not complying, or on paper they’re complying, but actually not providing disability competent care, who do you go to?

Chanda Hinton

Yeah, exactly.

Chanda Hinton

Well, and I think too, you can bring it up to your local Medicaid department, which we have. And so we have a great relationship with them and there’s good things that we work on with them. And then there’s things that we have to just make sure that we’re going through conflict resolution with them on in one of these and this piece is one of those, because we made it very clear that we are failing in that area here in the state of Colorado. And they even did a very intense kind of evaluation. The evaluation showed exactly everything that I was communicating to them, and I’m sure that that is just sitting on a shelf because nothing’s been done about it. And so it’s very interesting.

And again, right now, I’ve stepped away from advocating in that area just because there’s so much other things going on. But again, every time something more comes along, the disability competent care always gets pushed to the back. And I’m like, “So how long from the history of time, all the things that we’re all going to continue to come up against in the health care community, in the politics, in the Medicaid, the Medicare world, when is it ever going to happen?” Because something’s always going to come up. So it’s just become a priority at some point, and I’m just not sure when it’s going to, it definitely would need to have a pretty significant advocate kind of movement to occur.

Lauren Carboni

Yeah, I think you’re right. And I agree with you and it should be a priority, and maybe we can brainstorm some ideas to try and keep disability competent care as a priority for legislation. Let’s shift gears slightly. The majority of your participants are Medicaid or Medicare. There’s been a lot recently regarding the Medicaid program at the federal level, H.R. 1, the 2025 Budget Reconciliation Act was passed, that over time we’ll see a significant cut in Medicaid. I think I saw up to a trillion dollars. How are the cuts to the Medicaid program going to impact the center and your participants?

Chanda Hinton

Yeah, , in addition to those pieces that you just shared, here in Colorado, we’ve just gotten a budget that has been dropped by our governor, and it does look like the Medicaid department is going to be facilitating whatever cuts they can to not only meet some of those federal requirements, but some other components here. And some of that will be impacting our participants outside of the center as just an individual who is on Medicaid or Medicare, Medicaid specifically, such as those that would definitely get SNAP or individuals that are on certain programs where they rely on caregivers that get them up every morning and put them to bed every evening. There’s a provider rate that was increased during July of 2025, and that increase now has gone back. So they’re now having to navigate, oh goodness, if I just gave some raises to some of my caregivers, I’m either now taking that raise back or I’m going to have to reduce my caregivers.

And then again, that might result in, well, I’m sorry, I can’t work for you. If you just gave me a raise and now you’re taking, so it puts individuals with disabilities in some really awkward positions. The other component that I know is that with the governor’s budget that was just dropped to help make some of those Medicaid cuts is that there might be… The budget does say that there’s going to be another provider cut, doesn’t… It directly impacts the individual. I think that one thing about provider cuts versus what’s getting cut off to an individual, there’s so much cross reference between those two because one always impacts the other. And so there will be another one. They have not defined in specific details what that cut looks like. So our pro bono lobbyist is combing through the government’s budget, and we’re making sure that, one, the CIH, the complementary and integrative health waiver is not one that’s being considered the program at all, but then…

Lauren Carboni

Got it. Yeah. That’s still going to be maintained and that there’s not budget cuts to the waiver program itself.

Chanda Hinton

Yes, we’re working on just ensuring that that’s not one that would be coming down the radar and that whether when they talk about those additional provider cuts, because they’re giving kind of a formula that says that they have to meet a certain percentage to the cost of Medicare. And so there’s still a lot of unknown right now, but I would say that our participants are starting to see it as it’s related to their SNAP or their home health care services and any other providers that they’re seeing under Medicaid, they may not be giving them as much time for care because if they’re not getting paid as well, they may not be able to take on as many Medicaid patients. And so it’s going to be interesting to see how this all unfolds because it’s trickling and you’ll hear one thing after another kind of happens.

Lauren Carboni

Yeah. Yeah, there’s definitely a lot of unknowns, but I think there will be changes. And you’re right, I think with the cuts both at the state and the federal, I think we’re going to see pressure put on providers to try and navigate how to continue to provide care that’s either uncompensated care or those who are uninsured or that Medicaid no longer covers and those who are going to be directly harmed are the patients. I think we’re going to see an impact on access to care.

Chanda Hinton

Yeah, Lauren, the only other thing I would add to that too is being optimistic too, is that I do believe the population that we serve, those with long-term support services back in the day, that was what Medicaid was founded from. It was founded for the most vulnerable population. And so in some capacity, I will say, it’s such an oxymoron, the long-term support service population does have a level of protection because I do believe when the cuts happen, cuts do happen, they’re a population that might be the last on the line. And so I just wanted to mention that because I do think that there is some safety net there with a little bit of provider cuts that will trickle down to the consumer.

Lauren Carboni

Yeah, no, that’s a good point. We have just a few minutes left. I want to hear what are future plans for the center? More upbeat, right? Let’s switch it up. Setting aside the Medicaid and uncertainty with that aspect, what are future plans for the center?

Chanda Hinton

Yeah, let’s do this. Feels good. So center is growing, which is amazing. It’s very interesting that we’ve chosen the time to do it, but we’re going to get through it, because just with the uncertainty, I think funding sources through foundations and individuals that of wealth and that love to give to organizations, they even have senses of uncertainty. And so we’re in the midst of a capital campaign. We’re building an adaptive gym, an adaptive yoga room with some extra treatment rooms just so that we can really not only expand the services that we do today because we are growing to capacity on what’s the services we’re offering today, but that extra 6,000 square feet that we’re going to… Because we’re currently in a 12,000 square foot facility currently, we only use 6,000 of it. So we’re going to break the wall and go through and really add some more space, adaptive gym and adaptive yoga room, which we believe…

Lauren Carboni

That sounds amazing.

Chanda Hinton

Yeah, which is just another component for our participants. Again, we believe in movement. We always believe that movement is life, and we believe that the services that we offer and how it collaborates with, often people ask me about traditional care and I’m always like, “We’re the blend of the two. We don’t like to separate the traditional. We still want our primary care.” Having conversations with our massage therapists and our adaptive gym folks having access to our behavior, it’s all supposed to be working together. And so it’s exciting to add this component because this extra movement and rehabilitation that we can offer our participants is going to be just another layer of health maintenance that they deserve.

Because right now, they can’t go to just a… If they roll up to any sort of fitness gym, there’s very little… There’s probably not even one, but there are a few that maybe have something that you can try to do, but you can’t. You can’t independently work out or exercise on your own. And it’s so important to get your heart rate up every day. There’s endorphins that are released. Again, our bodies were really meant to have all those things and we’re going to create the opportunity for our participants to have that.

Lauren Carboni

Yeah, that’s incredible. And exercise is such a good preventative measure for whole body health, whole person health from physical and mental standpoint. That’s incredible. I don’t think I knew that you were in the process of doing that. I love that. I guess, so you’re in the middle of the capital raise, so can folks donate? How? If I want to donate, can I just go to the website and donate

Chanda Hinton

Yeah, our website, the chandacenter.org, there’s a donate button, you can donate in any capacity that you feel

Lauren Carboni

Awesome. Well, thank you so much for chatting with me today, Chanda. I really enjoyed our conversation. Is there anything else that we haven’t covered that you want to talk about?

Chanda Hinton

I’m sure there’s a lot, but I think that what we did was perfect. I think we touched on the pieces that I think were essential to today’s time. So thank you again so much for having me.

Lauren Carboni

No, thank you. And thanks to the Chanda Center for Health team. Keep doing the good work and ensuring that your participants get health care that they need, deserve, and keep putting up the good fight to make sure that those with long-term physical disabilities have a voice and a seat at the table, and hopefully we can push the needle in the direction of disability competent health care being the norm everywhere, not just at incredible centers like yours. But yeah, thank you again. Judy, back to you.

Judy Waltz

Thank you, Lauren, and a special thank you to Chanda Hinton of the Chanda Center for Health for a great discussion. We appreciate you taking the time to join us today. We want to thank everyone for listening to the Health Care Law Today podcast, your connection to timely legal updates in the health care and life sciences industry. We encourage you to subscribe to this podcast or to 麻豆传媒’s Health Care Law Today blog at healthcarelawtoday.com. If you like this show, don’t forget to subscribe and be sure to rate us five stars. Until next time on the Health Care Law Today podcast, I’m Judy Waltz at 麻豆传媒 & Lardner. We appreciate you joining us.

This episode features a conversation with Marshall Keen a summer associate in 麻豆传媒鈥檚 Dallas office. In this discussion, he reflects on growing-up in Blanchard, Louisiana, earning his undergraduate degree from Louisiana Tech University and attending SMU Dedman School of Law. Marshall discusses how he completed undergrad in three years and shares why SMU Law was his first choice. He also gives advice to new law students on how to handle the many uncertainties of the early days of law school and how he navigated finding a job. Marshall also discusses his experience as a summer associate at 麻豆传媒. Finally, Marshall reflects on the importance of working hard, being humble, and teachable.

惭补谤蝉丑补濒濒鈥檚&苍产蝉辫;笔谤辞蹿颈濒别:

Title: Summer Associate

麻豆传媒 Office: Dallas

Practice Area: Real Estate

Hometown: Blanchard, LA

College: Louisiana Tech University

Law School: SMU Dedman School of Law

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You can also find, and subscribe, to this podcast on all major podcast platforms including , ,  and .

This episode of The Path & The Practice features a conversation with Chemutai Shiow, a summer associate in 麻豆传媒鈥檚 Milwaukee office. In this discussion, she reflects on growing up in Franklin, Wisconsin, earning her undergraduate degree from the University of Wisconsin-Madison and subsequently attending the University of Chicago Law School. Tai details her unique path to 麻豆传媒 that included working at 麻豆传媒 for over three years, as patent agent, before leaving to attend law school. She discusses her decision to attend law school full-time, and her decision to return to 麻豆传媒 as a summer associate. Tai shares exactly what it is that has kept her coming back to 麻豆传媒 & Lardner and provides advice on the importance of working before law school.

罢补颈鈥檚&苍产蝉辫;笔谤辞蹿颈濒别:

Title: Summer Associate

麻豆传媒 Office: Milwaukee

Practice Area: Intellectual Property

Hometown: Oklahoma City, OK

College: University of Wisconsin-Madison

Law School: University of Chicago Law School

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You can also find, and subscribe, to this podcast on all major podcast platforms including , ,  and .

This episode of The Path & The Practice features a conversation with Nandita Raghavan, a summer associate in 麻豆传媒鈥檚 Los Angeles office. In this discussion, she reflects on growing up in Pleasanton, California, earning her undergraduate degree from the University of Southern California and subsequently attending the USC Gould School of Law. Nandita discusses on her decision to defer attending law school to teach for two years. She also provides advice on the best way to learn about law firms when you鈥檙e looking for a Big Law summer associate position. Finally, Nandita talks about her experience as a summer associate at 麻豆传媒 and gives great advice on the importance of knowing what you want out of law school.

狈补苍诲颈迟补鈥檚&苍产蝉辫;笔谤辞蹿颈濒别:

Title: Summer Associate

麻豆传媒 Office: Los Angeles

Practice Area: Litigation

Hometown: Pleasanton, CA

College: University of Southern California

Law School: USC Gould School of Law

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You can also find, and subscribe, to this podcast on all major podcast platforms including and .