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Point by Point

Point by Point's video series highlights informal conversations from leaders within Waller who share industry insights, advice to younger lawyers, and their reasons for why Waller is unique.

Point By Point: Colin Luke discusses development at Waller

Morgan Ribeiro has a conversation with Colin Luke about his 25-year career, healthcare trends and challenges, working at Waller, and much more.

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“Our lawyers are committed to healthcare. It's not an afterthought, it is the bread and butter of Waller.”

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Colin Luke // Partner

Colin Luke has extensive experience in healthcare transactions and regulatory issues involving a wide range of providers in the academic, governmental, non-profit and for-profit sectors. He is routinely involved in Certificate of Need matters, joint ventures between physician and other types of providers and sales or mergers of healthcare providers.

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  • Transcript

    Morgan Ribeiro: Colin, as the leader of our healthcare compliance and operations group, looking forward to this conversation today and thanks for being with me.

    Colin Luke: Thanks for having me. I appreciate you doing it.

    Morgan Ribeiro: So you have been practicing in healthcare law for 25 years or so. To get started, I'd first like to talk about your practice and the trends that you're seeing across the healthcare industry, the types of issues that your clients are facing today. It's certainly an interesting time in the industry. Would also like to talk about your role as a leader in the firm and the culture here at Waller and mentorship and how the practice of law itself is also changing right now. But to get us started, I'd like to hear more about your practice and the work that you do with clients.

    Colin Luke: We're fortunate enough to represent a number of different types of providers. It's very challenging and changing times for healthcare providers, but we have clients in the acute care space, in the ambulatory surgery space, in the general outpatient care space, and then large physician practices. It's a varied practice. We're not doing the same thing every day and we're all about institutional improvement and change and helping them address the ever-changing healthcare regulatory environment. We want to be partners with our clients, understand their business objectives, and help get them to a "yes" answer and still stay compliant.

    Morgan Ribeiro: Great. And I know your practice is somewhat interesting because you're on the transactional side of things and working with clients on deals and joint ventures, mergers, acquisitions, but also that day to day regulatory compliance. It's obviously an interesting time for all providers. Would love to hear more from you about the work that you're doing with hospitals and health systems and the challenges that they're facing right now.

    Colin Luke: I think most hospitals and health systems realize they've got to have either an affiliation or a scale to work for the future. They're increasingly becoming partners with their physicians. They're, in many cases, doing joint ventures. They're employing physicians in much greater numbers, particularly specialists, and they're looking for academic health system affiliations. And we are fortunate to represent those and they've really had to adapt their workforce. Particularly with COVID, many providers are burnt out. And that means they've got to have challenging ways to recruit and to retain staff and to look at it, what is going to have the best impact for the community. They can't be all things to all people, but with technology rapidly being utilized in healthcare, they can bring in the Mayo Clinic, for instance, and do telemedicine. So they've got world class care, even if they're in a rural area or if they're an academic health system, they can affiliate with hospitals throughout the state and have those specialists rotate through those smaller hospitals and then follow up with technology.

    Colin Luke: So COVID has created a lot of opportunities just out of the crisis and it means that healthcare is still local, will always be local, and there'll be the hands on aspect, but it will be done in partnership across the country with the best possible specialization. Like most things, healthcare is becoming more specialized and this is an opportunity for hospitals to take advantage of that specialization. Ambulatory surgery centers are seeing procedures that historically would only be done in inpatient setting, and that would be things like total joint orthopedic care for the right patients, and then cardiac procedures, stints and interventional cardiac. And more and more of the ambulatory surgery centers are looking at that and doing 23-hour stays and serving much sicker and patients with more intense procedures.

    Morgan Ribeiro: I'm curious what specifically is changing and how providers are preparing for that. I know that's a big piece of our practice and the work that we do with our healthcare clients.

    Colin Luke: It means that physicians can be incentivized to look at outcomes and receive compensation in ways that they could only do so in special accountable care organizations or in a non-governmental sense. But this opens it up for some common sense solutions you can pay to put certain technology in a physician's office that's really going to be cost effective, save the system money and get better outcomes and not run afoul of the START act or anti kickback. Really a lot of common sense solutions that I think will improve healthcare and save costs.

    Morgan Ribeiro: So Colin, you work with hospitals and health systems, many of which are located in rural areas. Any advice that you have for hospitals that are looking out at the future and any success stories that you can speak to of those that really saw the future, had a leadership team and a board that worked together to map out that plan?

    Colin Luke: I'll give one case study and it's been a phenomenal turnaround. It's visionary leadership at the board level, at the CEO level, and that's Cullman Regional in Alabama, which has become one of the true success stories. It's now become a regional powerhouse. It saw the opportunities to employ physicians and to stop out migration. Prior to the current leadership structure, they were losing a lot of their patient base on key specialties either to Birmingham or Huntsville. It's because they did not have the physician relationships that were necessary to let people stay, and to realize there's a choice, you've got to work for every patient. It's putting real business discipline in a rural hospital, recruiting the type of physician that is going to attract the local population base and it's doing joint ventures and new services. I mentioned earlier that healthcare is moving to an outpatient space. Cullman focused on that joint venture for an ambulatory surgery center put in a number of urgent care centers and clinics, and brought healthcare to many local communities that really didn't have that in surrounding areas. It was a community partner. They have increased their number of beds, they've greatly increased their bottom line, which all gets plowed back into new services.

    Morgan Ribeiro: So what advice do you have for the hospitals that have not gone through that, that transition? And maybe they're looking at it, what are the questions that their board members need to be asking of management?

    Colin Luke: "What resources do we have?", "Do we need to affiliate?", that's certainly one option and there are a lot of, as mentioned, academic options that are out there where they can have some of the world class care locally to keep people there. "What can the community do to support?", "Is it tax levy?", "Is it helping them recruit key physicians?" And then how can they better partner with the physician community and make sure they educate the community on the particular issues that a hospital's facing. Sometimes people think a hospital's going to be there regardless, and that's not the case. Been involved in another community where the mayor really understood he could not recruit industry unless he had a really first class hospital and he went out and partnered and got the funding and that allowed them to get one of the largest economic development projects in the state. He asked those questions. He didn't have a background in healthcare, but he was responsible for the turnaround in recruiting the type of physicians that can achieve that turnaround.

    Morgan Ribeiro: So, I want to shift gears here and talk more about Waller and our healthcare practice. I know you made a move over to Waller several years ago, have spent time at some other law firms as well as being in-house at a healthcare company. What attracted you to Waller and what was it about the healthcare practice?

    Colin Luke: I knew Waller of course, being in the healthcare space, and it's the preeminent healthcare firm, in my opinion, in the country. Always have found, and I've been here now eight years, but lawyers committed to client service, committed to staying on top of changing regulations, and, importantly, it's a friendly place to come to work. Your colleagues are going to support you and they're committed to healthcare. It's not an afterthought. It is the bread and butter of Waller. That's what attracted me and it's got very good leadership, and has a vision to not be all things to all people, but to be the best in some key areas and to attract the best and brightest committed to the healthcare space.

    Morgan Ribeiro: You've talked about the attracting talent and recruitment. I want to switch over to more of the retention and development, which is just as equally important into that talent that we're bringing in and that we're training them up. That we're able to retain them and that we see them become partners and really invest in the firm. I know that's something that you do very deliberately and I can think of a number of examples of attorneys that have worked with you for a long time. I know that that's something that you really focus on. Can you talk more about your role as a mentor?

    Colin Luke: We have an objective here. We want to turn our clients over to the next generation, and we're only going to be successful as a firm and as partners if associates and junior partners feel empowered. And I was fortunate in my career to have mentors that brought me along, gave me opportunities and health law and want to do the same. We invest a lot in going to conferences, whether it's virtual or in person, and staying cutting edge and our knowledge base and want to continue that. And we also want our younger lawyers to be capable of business development, to be comfortable, to be building relationships at their level in the organization. You're not going to be successful in a law firm if everything is a zero sum game, and we think we will grow our client opportunities and long term relationships if we allow our younger lawyers to be involved early on with client contact.

    Morgan Ribeiro: Waller has a reputation in all the markets where we have offices, but also elsewhere across the country and really giving back, whether that's through financial contributions or sitting on a nonprofit board. Talk to me more about your personal investment in the community and why that's important to you.

    Colin Luke: It's really part of the fabric of Waller and it's something the communities have been good to our firm good to me personally, and we have an obligation to give back. Hopefully we're making a difference; I believe we are. We want to set a precedent so that younger lawyers feel comfortable doing that. We give credit for pro bono work and community involvement and it enriches our experience as a lawyer, I think makes a difference in the community. I've been fortunate enough to be president of the Birmingham Zoo when it went from a governmental city department to a private 501(c)(3), and also to work with the Alabama Symphony and others. It enriches what I do and helps me understand the community and hopefully serve our clients more effectively. It also is a good team building exercise if we're involved with a charitable cause. As a firm or a team, I think we get to know each other that much better and get to our community that much better.

    Morgan Ribeiro: Absolutely. I want to go back to something you mentioned earlier, just in terms of client service and the way that we deliver services to our clients. Our goal, as you mentioned, is to really help them navigate their business issues or achieve their strategic objectives. Can you talk to me more about that, particularly in your area of the law where there could certainly be a number of times where we could say, "Nope, you just can't do that", but instead, finding out a way to navigate that? Is that something unique to us?

    Colin Luke: I think we're more proficient at it than other firms because we have long term relationships. We do invest in the relationship outside of billable hours and really understand what our client strategic objectives are. And so when they do a transaction or they have a crisis, we see how it fits within that. Our obligation is to help them achieve those objectives by giving them legal and business savvy ways of achieving those short- and long-term objectives. We're not good lawyers if we say no all the time. That is easy to do and it's certainly less risky for us, but we feel like we know the law and we can help them in most any circumstance get close to what they want to do, even if it's a different structure.

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