Health care lawyer facilitates novel solutions to opioid crisis

By Pat Murphy
BridgeTower Media Newswires
BOSTON, MA — The opioid crisis has the health care industry on its heels.

“We have EMS services that are completely overtaxed and hospital emergency rooms that are completely clogged,” says Joel K. Goloskie, a health care attorney who represents clients in Massachusetts and Rhode Island.

Goloskie, of Pannone, Lopes, Devereaux & O’Gara in Boston, is helping hospitals and communities implement creative strategies to manage overburdened emergency services and spiraling costs that are the byproduct of the abuse of fentanyl and related drugs.

For example, Goloskie has helped one community navigate potential legal barriers to a program under which a health insurer provided to a local EMS a sports utility vehicle for transporting drug abuse victims to a doctor or health center of their choice instead of an ER. The transportation is made available to patients once responders determine that there’s no critical medical situation involved.

In addition to relieving the burden on an overtaxed hospital, the cost savings in avoiding an unnecessary trip to the ER can be in the thousands of dollars, according to Goloskie.

“Patients frequently prefer to go to a health center because they have relationships with those providers, and the providers have a stake in their long-term well-being,” he adds.

Goloskie says that state anti-kickback laws often pose an obstacle when health care entities, particularly providers, try to implement an innovative solution to a problem like the SUV donation program he worked on (Goloskie declines to identify the client or the community).

“No matter how well-intentioned, you can never give money that may generate a referral your way,” he says.

Goloskie was able to get around the anti-kickback issue for the SUV program by having a health insurer participate. He explains that anti-kickback laws don’t preclude an insurer from providing a community with a van or SUV that can transport opioid abuse victims in non-life threating situations to their provider of choice.

“The insurer is not getting any referrals, so there’s not an anti-kickback issue there,” he says.

Everyone has a financial stake in the spiraling costs caused by opioid abuse, as emergency and medical services are typically paid for by private health insurance or by the taxpayer through government insurance like Medicaid, Goloskie adds. And often hospitals face the prospect of eating the cost of emergency care because many overdose victims are not insured, even though they may be Medicaid-eligible.

“Fortunately, you can get retroactive coverage for Medicaid,” he says.

Goloskie finds his own practice becoming more analytics-focused as the privacy and security of health care data have become primary concerns of his clients. In turn, the health care industry is turning to analytics to come up with innovative strategies to address the problem of opioid abuse, he says. Clients have been coming to him to ensure any such plans are legally compliant.

For example, one of Goloskie’s clients has a program that tracks claims data to identify patients on medications or combinations of medications that the U.S. Food & Drug Administration have flagged as posing an increased risk of an adverse drug event.

Goloskie says analytics can also flag the “problem prescribers” of opioids.

In terms of privacy concerns with the use of such data, Goloskie points to 42 C.F.R. Part 2, the federal regulation governing confidentiality of patient records indicating substance abuse.

“Part 2 allows a provider to use its claims data,” he says. “So the provider is absolutely empowered to identify its problem prescribers and implement strategies for meaningful interventions at the most critical points.”