Recommendations on a Reformed Health Law Curriculum

Peter M. LeiboldJune 6, 2013

Background• Kevin Outterson’s research from AHLA members

on law school curriculum spurred collaboration.

• Spurred by Kevin’s interest, AHLA established a Health Law Curriculum Steering Committee.

• The Steering Committee recruited over 100 volunteers to help with five working groups.

3%

22%

43%

29%

3%5%

27%

45%

20%

2%

0%

10%

20%

30%

40%

50%

Very Dissatisfied Very Satisfied

Preparation to practice health law Practical knowledge & skills

32%% Satisfied:

22%

Kevin’s Research on Satisfaction with New Health Lawyers

Background• Five Working Groups – Academic Matters/Practical Problems Compilation

– Kathleen Boozang; Kevin Outterson– Law Firm/Employer Interests – Melissa Markey– State Law/State Bar Associations – Peter Pavarini– Health Law Clinic/Pro Bono – Harvey Tettlebaum– Volunteer Research/Written Work Product –

Nicole DiMaria

Why Now?

6

General Views on Health LawFuture of Health Law

0%20%40%60%

57% 38%

Would highly recommend Health Law to a law student (% responding 8-10)

Highly Recommend0%

20%

40%

60%

66%

7

8

9

Why Now

What best describes your employment?

Solo Practitioner

Other

Academic Institution

Government Entity

Small Law Firm

Medium Law Firm

Large Law Firm

In-House Counsel

0% 10% 20% 30% 40% 50%

0%

5%

5%

5%

9%

15%

18%

42%

What percentage of your work is best described by each of the following health law practice areas?

17%

23%

8%

17%

14%

32%

33%

OtherComplianceMalpracticeAdministrativeLitigationRegulatoryTransactional

Generally, whom do you represent in your health law practice?

Individuals

Life Science Companies

Government Agencies

Other

Health Insurance Companies

Other Non-Physician Primary Care Providers

Individual Physicians

Post-Acute Care

Physician Groups

Hospitals

0 50 100 150 200 25020

25

31

36

50

70

89

98

152

211

Other Non-Physician Primary Care Providers

What subject areas are included in your health law practice?

Other

FDA Law

Bioethics

Medical Malpractice

CON

Clinical Research

Antitrust

Tax

Real Estate

Healthcare Finance and Administration

Licensure

Corporate Law

Reimbursement

Medicare and Medicaid

HIPAA

Fraud and Abuse

Compliance

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

9%

21%

23%

25%

32%

36%

39%

39%

41%

58%

71%

71%

74%

83%

84%

87%

89%

What statement most accurately reflects your firm, business, or agency’s health law hiring practices?

New law school graduates to practice health law

Lawyers with at least 1-2 years practicing law, but not necessarily in healthcare

Lawyers with at least 1-2 years of health law practice

Lawyers with 3 or more years practicing law, but not necessarily in healthcare

Lawyers with 3 or more years of experience in health law practice

0% 10% 20% 30% 40%

How strongly would you value the following attributes in a recent law school graduate for a health

law related job at your firm, business or agency?

Other related graduate level degree with emphasis on health

Masters of Law in Health Law

Significant number of health law courses in JD transcript

Health law certificate received from a JD program

Prior non-legal experience working in healthcare or life sciences

0% 10% 20% 30% 40%

13.30%

19.10%

9.80%

14.00%

28.60%

*Graph shows only Very Strong responses

Rank in the order you would find the most useful skill for a recent law school graduate interviewing for a

health law position at your firm, business or agency.

Drafting legislation, rules and regulations

Drafting basic administrative agency materials

Drafting correspondence with clients

Analyzing federal or state laws and regulations

Making oral presentations

Gathering facts from clients

Drafting basic litigation documents such as motions

Analyzing basic client problems

Analyzing basic fraud and abuse scenarios

Drafting basic contracts

0% 5% 10% 15% 20% 25% 30% 35% 40%

*Graph shows the percentages for respondents top ranking only.

How important would you find the following courses on an entry-level candidate’s JD transcript?

Other

Writing/paper-based course

Course focused in a specific health law subject area

Antitrust

Statutory Interpretation

Basic course in Tax Law

Corporate/Business Law

Administrative Law

Survey course in Health Law

0% 10% 20% 30% 40% 50% 60% 70%

*Graph shows only Very Important responses

Do you find the students who participated in

health law externships, journals, moot court, or clinics are better prepared for health related work

at your firm, business or agency?

74%

26%

YesNo

How important is it for a new health lawyer to have a broad understanding of the business

side of healthcare?

Very Im

portant

Somewhat

Importa

nt

Not Very

Importa

nt

Not Importa

nt At A

ll0%

10%20%30%40%50%60%70%

How important is it for a new health lawyer to understand how healthcare is paid for?

Very Im

portant

Somewhat

Importa

nt

Not Very

Importa

nt

Not Importa

nt At A

ll0%

10%20%30%40%50%60%70%80%

How long does it typically take for most recent law school graduates to become proficient in analyzing

basic health law issues?

More than 2 years

Between 1 and 2 years

Between 6 months and 1 year

Less than 6 months

0% 10% 20% 30% 40% 50% 60%

Transactional Regulatory Litigation Administrative0%

20%

40%

60%

80%

100%

120%

15% 17% 9% 17%

35% 35%38%

38%

39% 36%35%

36%

10% 11% 16%9%

1% 0% 3% 0%

54321

How would you rate most recent law school graduates' preparation for practice in each of the following health law practice

areas?

On a scale of 1-5 with 5-Able to analyze complex issues; 4-Able to analyze basic issues; 3-Basic understanding of concepts but additional instruction needed for effective analysis; 2-Some background knowledge but additional instruction in basic concepts needed; and 1-Little to no background knowledge

Do you believe law schools can enhance a law student’s preparation for a career in health law with

initiatives specific to the field of health law?

92%

8%

YesNo

What initiatives, if any, could law schools take to improve recent law school graduates’ preparation to

enter health law practice?

Other

Increase access to transactional skills-based courses

Increase number of health law specific externships and clinics

Increase the depth of health law subjects covered in health law courses

Increase number of health law subjects covered in health law courses

0% 20% 40% 60% 80%

Curricular Recommendations• Included academics and practicing lawyers.• Seeking input from the broader health law

academic community.• Designed to support law schools in curricular

development.• Goal - aid schools in producing students

substantively ready to practice health law upon graduation and support their efforts to integrate skills development into their curricula.

Curricular Recommendations• Survey Class– Healthcare marketplace, delivery and finance sys– Federal healthcare reimbursement programs

(including safety)– Fraud & Abuse (CMP, FCA, Stark)– Federal Health Information Privacy and

Security/HIT/HIPAA– Provider Credentialing/Peer Review/NPDB

Reporting/Corporate Practice of Medicine

Curricular Recommendations• Survey Class (contd)– Commercial Insurance/Managed

Care/ERISA/Exchanges– Tax Exempt Organizations & Governance– Patient Care, Informed Consent, Patient Rights,

Advance Directives– Public Health/Wellness

Curricular Recommendations• Health Law Concentration (In addition to survey course

concepts)– Healthcare Antitrust– Medical Malpractice Coverage and Defense– Life Sciences (FDA regul of pharma and devices/human subject

research)– Physical and Mental Disabilities (ADA, psychiatry, commitment)– Bioethics– Securities law– Healthcare finance and administration– Administrative law

An Unvetted Idea for the Third Year

The Interests at Stake in High School• Students– All are disadvantaged and cannot afford the tuition

for a Don Bosco education• School– Need to find the resources to carry out mission to

provide a top notch education to the needy• Businesses– Have a strong interest in a well-trained, educated

workforce and have less skilled work that needs to be done – at the right price.

The Interests at Stake in Law School• Students– Desire for jobs to help pay back mountainous debt– Need for legal training to qualify for jobs

• Law Schools– Needs to find the resources to carry out mission to prepare

superior legal minds as well as train in specific skill sets• Private Employers– Have a strong interest in a well trained, educated work

force and have less skilled work that needs to be done – at the right price.

Law School

Law Firm 3rd Year Law Students

On the job training

2 days of work a week

Nego

tiate

s int

erns

hips

20K

per p

rivat

e in

tern

ship

10K

per p

ublic

inte

rnsh

ip Pays tuition minus 20K or 10K

Appropriate discount on tuition

3 days of wraparound classes

Negotiates internships

Collaboration• This is an important project where the private

sector and the academy should work hand-in-hand to achieve our compatible goal:– Training and then employing skilled, diverse, and

intellectually curious lawyers who can analyze and suggest solutions for complex health law issues.