Photo provided by the firm.
Attorney Harry Nelson says the unpleasantness of debates around healthcare led him to write, along with co-author Rob Fuller, “From ObamaCare to TrumpCare: Why You Should Care," which examines the legacy of the Affordable Care Act and what changes may lay ahead.
"The book is a call for constructive dialogue," says Nelson, a 1992 University of Michigan School of Law graduate. "I hoped it would be accessible to everyone. The feedback has been great, with the highlight being a U.S. Senator ordering copies for each of their colleagues in Congress."
The founder and managing partner of Los Angeles-based Nelson Hardiman has represented clients in the healthcare industry for more than two decades. Beyond running his own firm, Nelson is an entrepreneur who has started a handful of ventures to serve businesses within the industry.
Lawdragon: What types of clients do you tend to represent?
Harry Nelson: I have a broad mix of traditional healthcare clients – including hospitals, pharmacies, labs, and physician groups, as well as healthcare IT and life sciences organizations. My clients are predominantly care providers, managed-care entities, and financial institutions – banks, VCs, and private equity groups. In the last few years, my practice has focused on regulatory and reimbursement problem-solving and strategy, including the transition to value-based care, for telehealth and other digital-health companies, behavioral and post-acute health providers, and life sciences companies, particularly ventures involving biologic products.
LD: What was your motivation in reaching a wider audience beyond your clients with your book?
HN: I had been discouraged by the toxicity of the public discourse around healthcare and the dearth of discussion about real issues. And after the election, I was inundated with requests from people – both clients and friends – worried about the future of healthcare under a President Trump. The book allowed me to properly answer people’s questions and afforded me the opportunity to contribute something positive to the healthcare debate by offering an honest vison while remaining politically neutral.
Since 2010, I’ve felt that healthcare is too complex for the black-and-white rhetoric that permeates the debate. To speak of ObamaCare or TrumpCare as all good or an unmitigated disaster is unhelpful. Irrespective of arguments about what’s right, on a practical level, when your waiter doesn’t have access to care and sneezes in your salad, that’s your problem, not just his. We should all be invested in establishing a system where everyone has access to care, but need to address serious and difficult questions that accompany that structure.
LD: More practically, what has the transition from ObamaCare to TrumpCare meant for your practice? What are you spending more of your time advising clients on and is this expected to continue?
HN: Like all change, the uncertainty around the transition has generated work across many sectors, particularly in addiction treatment and other areas of behavioral care, such as applied behavior analysis and children’s services. I’ve also been barraged by clients seeking advice about risks related to insurance reimbursement, whether it’s from a Medicaid rollback, changes in insurance plan design, or more aggressive payor audits and investigations.
LD: Is there a recent work matter or client that stands out as particularly memorable?
HN: Recently, a publicly traded, national direct-care company with dozens of locations across California contacted me when a state government agency accused it of the illegal corporate practice of medicine. I testified as an expert witness in the case where a loss would have forced the client out of the state. The judge took my testimony as authoritative because the agency was selectively quoting and relying on me, and dismissed the case.
LD: Why did you decide to open your own law firm instead of being part of a larger practice?
HN: I am too much of a contrarian and nonconformist to thrive in a larger more rigid firm. At 30, I gave up my partnership at a mid-size Chicago firm and headed to Los Angeles with my wife where I joined a solo practitioner who represented doctors in administrative proceedings involving their licenses, Medicare, Medicaid, and hospital staff privileges. It was an incredible education and the best professional decision of my life. It’s worked out extraordinarily well – we’ve grown to 25 lawyers – to have my own firm and to be able to develop a shared mission and vision.
LD: Can you share some strategic plans for your practice or firm in the coming months or years?
HN: I think about growth and strategy constantly. Personally, I subscribe to George Land’s transformation theory that growth is a repeating process: You go through periods of creative exploration of what’s possible, reach the point where things begin to work and progress becomes more incremental, until you hit the threat of external disruption from new sources of complexity. In our world, that includes non-legal competitors, disruptive technologies, and the commoditization of data. At these points of challenge, we either reinvent ourselves and our organizations, using creativity to drive innovation and stay relevant, or we head down the path towards irrelevance, shrinking and losing talent.
Our growth is primarily predicated on our dynamic healthcare-specific talent and our ability to identify trends and challenges in the healthcare and life sciences industries. Hence, our biggest challenge is retaining our lawyers who get recruiter calls weekly. Additionally, we need to adapt to the way healthcare and bioscience are changing. As such, we are constantly on the lookout for ways to develop resources beyond legal services to solve client problems. For example, two years ago we launched a trade organization to help our behavioral health clients navigate the complex and evolving regulatory landscape.
LD: There are many high-quality firms out there. What do you do try to “sell” about your firm to potential recruits – how is it unique?
HN: We are a little bit of a “throwback” in the current mercenary era where lawyers switch firms ever more frequently in search of the biggest paycheck. We only hire people who we expect to become partners, and from the beginning, we are invested in their development in a profound way that big law firms can’t match. We offer an immediate education on the business side of practicing law by being radically transparent about our finances and our business challenges and successes. Most law firms treat junior lawyers like racehorses, keeping them focused on client work but shielding them from how the business works. We are also generous to a fault with supporting professional and client development.
While those top-down directives are selling points, our greatest assets are our attorneys and staff. We have a tight-knit, supportive, and conscious group with an open culture that sells itself to recruits. Finally, many candidates are attracted to the idea of doing complex legal work for significant clients in a smaller firm setting.
LD: Also, can you discuss what the companies you have launched have focused on? How much time have you spent on these ventures?
HN: As background, my experience is that while we have deep expertise and problem-solving ability, law firms are not the ideal delivery vehicle to meet every client need. Law firms deliver value when it comes to big legal battles and transactions. But hourly rates don’t work well for everything and, often, non-lawyers are essential to the solution.
For example, many of our clients needed long-term compliance help with organizational training and risk assessment. I hated getting calls from organizations after the “train wreck” occurred, and wanted to find a proactive, preventive solution to identifying and remediating risk. Then a post-acute care client asked the firm to provide these services through the law firm, but I found that, even beyond the rate issues, we lacked the clinical and IT expertise. After struggling with hand-offs to outside consultants, we decided to fill a void in middle market healthcare by launching Compliagent. Compliagent now provides fractional compliance officers, clinical nurse consulting, and other compliance counseling services, such as training, mock audits, and chart reviews. Our team works with acute care hospitals, pharmacies, labs, and behavioral health facilities.
Based on Compliagent’s success, we have continued to spin off ventures driven by client needs to solve problems. We identified gaps in the strategy consulting market, where regulatory and reimbursement issues were often neglected for healthcare providers, so we brought in strategists to form the RX4 Group.
I previously alluded to the American Addiction Treatment Association which fills a need for a membership and certification organization to disseminate information about compliance and develop best practices. We are doing ground-breaking work to develop certifications that will establish and improve standards of operation and patient standards of care.
Our latest venture is the Adaptive Healthcare Fund which provides financial and strategic support to entrepreneurs focused on healthcare transformation. Again, this endeavor was created in response to a need. Our regulatory expertise routinely brought us in contact with early-stage healthcare companies seeking legal advice and funding. Seizing on the opportunity, we built a team led by experienced hedge fund managers. And the response has been overwhelming.
LD: What do you do for fun when you’re outside the office?
HN: My wife and I have four kids, ages nine to 16, and our favorite family activities are skiing, golf, and the Los Angeles Kings. Currently, the family has a pretty ferocious NHL rivalry on Sony Playstation 3 which I am handily losing. I fare better in a FitBit competition with a group of friends, which keeps me motivated to get to the gym. I was born in Brazil, and all of my kids are dual citizens, so we are big travelers too.
Personally, I obsess over obscure single-malt whiskys and have amassed a decent collection that I love to share. Friends regularly visit for “vertical” tastings of my favorite distilleries.