Politics may often create strange bedfellows, but Greg Duckett claims his early political career not only inspired his active commitment to community service, but also prepared him to wear the multiple hats he has acquired during his 25 years with Baptist Memorial Health Care Corporation (BMHC) system.
After earning his J.D. degree from the University of Memphis Law School, Duckett, now Senior Vice President & Chief Legal Officer for BMHC, worked with U.S. Senator Al Gore and the Clinton/Gore transition team before Memphis Mayor Dick Hackett recruited him in 1988. First as Director of Public Service, then Director of Housing and Community Development, Duckett became both the youngest Chief Administrative Officer and the first African-American to achieve that role for the City of Memphis. It was a role he held until Hackett's election loss to Willie Herenton in 1991.
In search of employment, he bypassed offers from law firms and private companies when, during his discussions with Baptist's leadership, he recognized the service component inherent in the healthcare field.
"I was a little intimidated initially because of how regulated healthcare is, and the learning curve I knew I would have to undergo," he confided. However, he added, "I quickly realized that things were changing at such a rapid pace I was not that far behind, because we were all learning!"
During the quarter century since he joined Baptist as a vice president in 1992, Duckett has seen--and created--significant change. As the original architect of their in-house legal program, he built a structure that includes eight other staff attorneys, and keeps another 28 attorneys busy on retainer elsewhere, focusing on such specifics as tax issues, certificates of need, and mergers and acquisitions.
In 1994 he was promoted to Senior Vice President and became the first African-American chief legal officer for a major healthcare corporation in Memphis. As such, he coordinates and oversees all the legal activity for BMHC, a $2.5-billion enterprise that encompasses 21 hospitals, more than 20,000 employees, and more than 400 physicians employed or under contract.
"My principal responsibility," he said, "is to be the quarterback for all those activities."
He identifies his toughest challenges as staying abreast of reimbursement and regulatory changes, and dealing with mergers and acquisitions, specifically the onboarding of added hospitals such as the soon-to-be-opened Crittenden County facility, which pose both legal and operational challenges.
He regards the future of the Affordable Care Act as a major continuing challenge to healthcare providers. Although the number of uninsured patients should theoretically decline as Medicare reimbursements decrease and Medicaid benefits expand, thus covering more people, who have not worked in Tennessee and Mississippi, where Medicaid roles were not expanded by the states.
"As a hospital, we were hit with the reductions in our Medicare reimbursements, but we didn't get the increase of uninsured being insured," he notes. The best response, he believes, is to be as efficient as possible and to negotiate appropriate managed care contracts, which is becoming increasingly difficult.
He cites 340B Pharmacy Pricing, a CMS program which allows institutions that treat underserved (i.e. Medicaid) patients to purchase certain drugs at deeply discounted prices. The pharmaceutical industry is lobbying to modify that program - reductions which could prevent Baptist's delivery of care to a number of needy patients - and Duckett continues to write letters of opposition.
He warns other issues to watch, include:
(1)Physician contracting. Extremely closely regulated, it presents a minefield
of issues: The only way a patient can be admitted and receive hospital care is by a physician's order, but, he explains, "Federal laws (anti-kickback and Stark) prohibit me from incentivizing a physician to make referrals to my facility. As such, any contractual and/or employment arrangement for a not-for-profit organization has to be at arm's length--so there is an added cost, separate and apart from compensation, that this organization has to incur for any physician that is contracted and employed."
Part of that cost requires third-party validation as to the reasonableness of the compensation that is being paid, he further points out.
(2) Corporate compliance. The False Claims Act protects whistleblowers, allowing an individual or employee to initiate 'qui tam' action if the organization has submitted false bills to the federal government. If proven true, the individual can get up to 25 percent of any recovery by the government. Duckett says fraudulent intent may be misperceived in cases where honest mistakes have been made on an incorrect bill, so watchfulness and proactive compliance checks are essential.
(3) Telemedicine raises questions, too: Must a physician in Memphis be licensed in Mississippi in order to provide a telephone consult to a Mississippi patient? Legislatures should be encouraged to make changes that allow healthcare to use technologies that can lower healthcare costs.
Duckett's busy calendar is complicated by his service on a list of boards that includes the National Civil Rights Museum, the Tennessee Board of Regents, the State Election Commission, the Riverfront Development Corporation, and the Greater Memphis Area Chamber of Commerce - opportunities where he can make a difference.
"Mindful of the economic disparity in this community, I want to play a role in doing whatever I can to help increase the pipeline for others to be considered, and develop a climate where one's gender, race, or ethnicity does not preclude them from reaching their full potential."
He still finds family time, however, to spend with his wife of 31 years, a daughter in law school, and a financial advisor son he meets for golf.
He feels strongly that "The future of the delivery of healthcare depends on a partnership - a partnership between physicians, allied providers, hospital providers and all. We can no longer, with scarce resources, come to the table with a 'we-versus-they' mentality."