← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Carl Bergetz on Legal Strategy, Policy, and Patient-Centered Growth at Rush
00:25:26
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- [00:02]
A
This is where healthcare leadership comes together. Becker's 16th annual meeting brings more than 3,500 hospital and health system executives and nearly 800 speakers to Chicago, April 13th through the 16th. This year's event includes keynote conversations with Dallas Cowboys legend Troy Aikman and former President George W. Bush. For the agenda and event details, visit Beckershospitalreview.com and click on the Events tab in the upper right. We're looking forward to hosting you in Chicago.
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B
This is Laura Dardo with the Beckers Healthcare Podcast. I'm thrilled today to be joined by Carl Brigetz, chief legal officer and general Counsel at Rush University System for Health. Carl, it's a pleasure to have you on the podcast today.
- [00:44]
A
Thanks, Laura. Good to be here.
- [00:46]
B
Absolutely. Now, I'm excited for our conversation because I know there's so much happening in the healthcare space and really things are moving at the speed of light in terms of policy updates and things you have to be considering on a daily and consistent basis. So I'm excited for our conversation to learn a little bit more about how you're looking at things at Rush and, you know, what is ahead. But can we start with Please introduce yourself and just tell us a little bit more about Rush.
- [01:09]
A
Sure, yeah. Like you said, I'm the general counsel and chief legal officer. I'm also the corporate secretary for the boards here at Rush, and I've been with Rush for over a decade now. And as I say that, I feel. I feel like I'm showing my age. But in any case, it's been a wonderful place to work. It's a great organization that I do feel, as big as we are, we are really community focused, and we're an institution that is really mission driven. And that's what's appealing to me and a lot of the people who work on my team is the fact that we do have the mission that we do have, and we're supporting the providers that execute on that. And that's great. And what is that mission? Well, it's to provide healthcare services to the communities on the west side of Chicago and. Well, anywhere but our main areas, west side of Chicago, the western suburbs, all the way out to Aurora, where we have a hospital out there, Rush Copley, Rush Oak Park Hospital, and then our downtown campus. So two community hospitals and a downtown academic medical center under the same corporate roof as the medical center is our university, which is a graduate level only. So graduate courses for medicine and nursing and allied health professionals. So I'm the lawyer for both aspects of that. And my team is the team that works on those aspects of both aspects of that. So that means we're working on research issues, higher education issues and faculty issues, as well as clinical issues and to more typical hospital matters that any GC of a hospital system is going to work on. So that diversity makes it a great place. It also integrates the kind of services we provide and the employees we have and train here at Rush, meaning people are tied into the academic function as well as they are into the clinical function. And that's relatively rare because there's only a couple other institutions that I'm aware of around the country where it's all under one corporate roof and that integrated and that. I think Mayo and University of Michigan are like that. But most other places really have separate corporations and separate legal teams and other types of corporate services teams dealing with academics in the university and then clinical stuff. So it's nice to have both. And we bring that to our patients and to our community. And we're tied into. Just like you were starting out, mentioning all the various policy and political issues that involve both universities and hospitals. We're dealing with both of it, or all of it, I should say.
- [03:39]
B
I love that. Yeah. I mean, there's so much to think about when you've got all sides of the stool there. Looking at the academics, the research, the education aspect as well as the clinical, and serving a hugely diverse population as well that you do at Rush. It's just amazing to see how you've grown and truly become a system serving the people now. When you think about just the last year or so, could you tell us about an initiative that you led? What did you do and what were the results?
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A
Well, I think the big one I have to talk about, just because it's in the news all the time, is our work in government affairs and legal's role in interpreting the political and policy and legislative and court landscape that's out there. So court opinions, because so much is happening. And at the start of last year, we stood up a group that we've had in place before. We had it back during the pandemic. It was a group that was an interdisciplinary group that was legally led to really intake all sorts of initiatives, executive orders, declarations, rule changes that were happening through the pandemic. Interpret them, understand them and their impact on healthcare generally and Rush specifically, and try to help work with operators to operationalize those. We restood that up because although the pandemic technically ended in 2023, I mean, from a legislative standpoint, we kept it kind of Percolating for a while. But then last year, at the start of last year, with the new administration starting, we knew there'd be a lot of change. And I don't think we anticipated it would be as much change and as quickly as. As it has been, but we knew there would be a considerable amount. And so we wanted to stand that up again. And we call it an LGA group, Legal and Government affairs. And. But it really involves a lot of other groups, from comms to clinical services to, of course, finance. Just really understanding what is happening in Washington and Springfield and even locally in the political and policy arenas and interpreting how those would affect healthcare and higher education, and then trying to see how we can implement anything that we needed to do to either get into compliance with those things or address them one way or another. From things like the proposed budget cuts, the cuts to research, the executive orders and various inquiries that were going on around dei, the various changes that happened over the course of that past year, that last year in gender, affirmed, care for minors, when it came to immigration issues, all of it. I make. I'm basically sounding like everything, and it kind of was because so much was driven in 2025 and continues to be by politics and government. And given that healthcare and higher education to maybe a lesser extent, but healthcare is so heavily regulated, we always know that muscle needs to be in shape and staying fit and growing. So we always try to work on those things. And what I should have mentioned, Laura, is that Government affairs also reports up through the legal department. So that's another function that's under our umbrella in the department. And so we've always been tied together in that way, which is great because that which happens in the government political space ends up having legal repercussions and therefore compliance repercussions. And so it just was incredibly important to strengthen that muscle this past year. Other people, like I said, it's an interdisciplinary effort across our system from, you know, the west side, Chicago out to Aurora and everywhere in between, to try to make sure we are understanding as best you can what's going on politically and governmentally. And that has been a really, really difficult, challenging, but also interesting thing, initiative, if you will, that. That I've had to lead. And in the context of doing that, actually we've done a lot of communications around the organization for that because like I said, we have a university. There's a lot of faculty and students who want to know and keep up to date as to what's going on, not just from the news that they read on their apps, et cetera. But how we are seeing it as an organization, we do a lot of communication around that. Some audio taped offerings to leaders and then more broadly to faculty and students. It's available so that we can explain some of the things that are going on that may be confusing to people, whether it's the changes to ACA and what happened with the House resolution, the Budget Reconciliation act from last year. But then as we continue with government shutdowns and pauses and things like that, people get understandably confused and want to learn more about it. And so we're there to help provide that understanding as best we can. So it's all done through that process, that legal and government affairs workgroup process.
- [08:40]
B
That'S fascinating to hear and helpful to understand some of the challenges that you've seen arise. And especially looking at the policy changes and shifts and then communicating that out to the broader system and organization. I can imagine, especially with an academic system, there are a lot of different folks and a lot of different impacts that come into play here. So when you are looking at the work group and the communications out, I think I'd be interested in learning just a little bit more about how you tailor some of those things in, you know, what you feel like. Maybe an example of one that was really successful, well received from the last year that made a big difference as people were operating and trying to figure out how to think and work differently in an environment that's always changing.
- [09:26]
A
Yeah, I don't know if I'd characterize it as something that was successful, may not be the word I'd use for it, but the one that maybe was more prominent was how to deal with with Immigration and Customs Enforcement, which ice, which was something that earlier in the year we anticipated might have an effect. Then in September, you'll recall there was the federal push here in Chicago to put more ICE agents and CBP on the streets. And we knew that as a consequence of that we might see some activity. And if you'll recall, there had been a executive order during the Biden administration that allowed hospitals, university schools, churches and the like to be sort of shielded from investigations by such officials. And that executive order was rescinded by the current administration. And that meant that there could be investigations and inquiries made by immigration officials into our institution, University Healthcare. And so we had to prepare for that. We had to make sure that our policies were well understood and train. We had policies obviously that to deal with law enforcement one way or the other. But ICE was a different thing to deal with than we had customarily seen, and certainly just the size and scope of it hitting Chicago when it did, we knew that there would probably be more issues revolving around that. And so, sure enough, we had a couple encounters, both downtown AD Oak park and in Aurora, where ICE agents did appear on campus. But what they. Once we got through some of the fog of it, when we first heard about things happening, we learned that what was more or less happening was ICE coming to the hospital because a detainee they had was in need of healthcare. And so it was important, obviously, for us to do our job, number one, which is to provide healthcare to the people. And so, you know, even if they had come, whether it's from, you know, an FBI agent or cbp, Chicago Police Department or any police department, any law enforcement, we see that a lot. And they would come in and we'd provide the care. And if they were a detainee or an arrested person, or let's say, a prisoner that would come in, we have a forensic patient policy, as we call it, so we know how to operate with that. With ice, it was a little different because we hadn't seen them as much before. And we also weren't necessarily sure at the beginning of it, like, what was the scope of their jurisdiction and things like that. And we worked through a lot of the issues around that which we've seen come to light in news media stories over the past few months in other locations, which is that, you know, they sometimes didn't use warrants or they used administrative warrants. And we had to make sure we were educating people on the need for a judicial warrant that was signed by a judge in this district. And that was very specific. We. We had this as a policy, Laura, and as a protocol, but it needed to be. People needed to be trained on it. Because when things like happen, when law enforcement shows up, it can be a little jarring to clinicians because they're not accustomed necessarily seeing that maybe in an er they might be, but not ICE officials. And they weren't accustomed to how we did business. And in my experience, you know, seeing them, working with them, a lot of them weren't your typical law enforcement. Right. So most law enforcement fairly well accustomed to dealing with a detainee being brought to a hospital for whatever reason, or a search that needed to take place, a subpoena that needed to be delivered. ICE just didn't fit that description in terms of how they operated and how their. What it seemed to be, their training around those kinds of things. So it was really important to make sure that our frontline staff, especially in the emergency room, which does see a lot of. A lot of dramatic stuff, was, was understanding the policy and the process because no matter how much, you know, how well you write something down until you train on it and actually until you live it, it's really hard to put into action when something emergent happens. And we did it, and I think it was a good job that was handled. There were some news media stories here and there that came out of it, but like I said, for the most part it was a case of officials bringing detainees in. Not doing a search here, but rather detainees who needed patient care. And that's what we're here for. What was again, also different, Laura, about it is because of the political sensitivities. Word got out pretty quickly and we saw in different inst. Is people coming to the hospital either to protest or to voice their concerns, or local officials contacting us about it and in some cases not understanding fully what was going on. In other cases, ICE not really fully understanding how they should operate. So, you know, I foresee that continuing to happen in that space just because of what we're seeing in Minnesota and Minneapolis, which is unfortunate. But I think the best we can do in an institution like ours, like every healthcare institution that can do best, is to get make sure your policies are down, of course, but that you have a process. Because policy is one thing, another thing that really almost make a process instinctive and really build the muscle around it and then train on it and talk to people about it and then debrief on it. We would debrief on it to make sure we understood what were some lessons that we could learn for the next time it happens. Because at least as far as this administration goes, they're going to keep trying this time type of activity. And so we want to make sure that we're prepared for it and put ourselves in the best position possible to de. Escalate, make sure that things aren't getting out of hand. And job number one, taking care of the patients that need the care.
- [15:11]
B
Absolutely. That's such a powerful example of having those processes and systems and then all understanding as much as possible how to apply them and what needs to happen in order to lawfully move through these processes and have any tensions de escalated. So I appreciate your thoughts there. And it was just a critical, critical thing to keep focused on at this moment and, you know, looking ahead of the next year too. Are there any other priorities or headwinds that you're really focused on?
- [15:37]
A
I think really, Laura, it's the same as what I said before. There's obviously other things, you know, managing the business and, you know, as legal counsel, helping to provide counsel around that in an increasingly difficult time from a standpoint of margins, you know, Medicaid, Medicare dollars being cut or at least made more difficult to obtain research dol different sort of frameworks of thinking about how those research dollars can be granted if they are at all. Basically, all of that translates into, and I should mention the ACA issue, which still hasn't resolved yet. Whether or not those are the changes that are happening in that space are going to result in more and more people, most likely it will, being without health insurance. The more we see of that, either less fewer dollars for that or fewer people with insurance, we're kind of heading in the opposite direction than we were heading after 2010 or so. That's unfortunate. But it is what it is. And as an organization that needs to have the money to be able to provide care and research and other things that we do, we're after figuring out how to make do with less or how to make do in a tumultuous environment where things are uncertain. I think that's another thing, Laura, that's really difficult right now is the uncertainty more so. I mean, I always sort of view things as the default setting for me is things are kind of uncertain. And it's our job to try to create some sort of semblance of normalcy. But it's really hard to do that when, you know, we're not even sure if the funding is going to be there for certain types of programs, even something as big as Medicaid. Right. Obviously there'd be funding for it, but what's the scope of it? So I think struggling with that and coping with that, which inherently has a lot of legal issues associated with it, is still top of mind. And then continuing forward with that group that I was talking about before, the work group, just constantly keeping the energy level there going good so that we can understand and follow in real time what's happening and make sense of it and adjust accordingly and hopefully mitigate where those risks are arising or we're seeing those risks. So I see this just continuing more of 2025 into 2026, and it probably just getting more and more difficult because a lot of the, as you know, with the House resolution, the budget resolution act that happened last year, a lot of the things that are going to impact Medicaid dollars directly aren't going to take place until after November of 2026. So we have to really prepare for those. We'll see what the legislature in Washington ends up doing, because there has been action by the House to kind of claw some of that stuff back or revert back to the way things were. But we have to operate thinking that, oh, these things will happen, these cuts will happen. These, these measures that are being taken to control budget from their perspective, are going to result in fewer people with insurance. We have to presume they will happen, and so we have to act accordingly. So to continue to function at a high level, in a very efficient way, in a nimble way, anticipating that those things are going to actually come to fruition, that's the most difficult thing. And that's what I see continuing focus for the next year.
- [18:58]
B
That makes a lot of sense. And, you know, just to take all of that seriously, the news coming out of the White House and policies, you know, I think that's a really smart approach and, you know, will be helpful. And then regardless of what happens, you'll be in a strong position to continue having that foundation of stability and ability to serve the community as whole. What do you think the hardest thing you'll have to do in the coming year will be?
- [19:24]
A
I think it's. I think part of it is going to be, you know, what I said before, continuing to make sense of it and communicate it and create a sense of, I don't want to say calm, but understanding amongst the people, both the workforce, faculty, students. That's a challenge. And it's, you know, making sense of what's going on is tough, and that's going to continue to take place. But I think I'm repeating myself now because I think the last thing I said about the fact that the financial impacts of a lot of those changes are going to start hitting more and more, especially later in the year, is going to be the biggest challenge. And that's. I do. I am concerned about it. I think everybody in healthcare should be concerned about it. Certainly everybody in the healthcare delivery of services space should be concerned about it. And, you know, we can mitigate and plan as best we can, although it's difficult to plan in such a very uncertainty framework and environment. And the other thing is to, you know, work on our own advocacy, you know, with. Through associations and through groups to try to make legislators and the administration and even locally, you know, our state and local officials understand what it is we're going through and how hard it is. It's. It is very hard. It's hard for a lot of people out there. These days, this is not, not a pleasant time. But for healthcare in particular, some very specific risks and issues and problems that are happening, some of them are happening anyway, but they're actually being exacerbated by what's going on in Washington. We hope that, you know, more rational and cooler HUDs will prevail in the coming year, but it's. That's not going to happen on its own. It's only going to happen by us paying attention to it, doing what we can internally to interpret and make sense of it and mitigate and then and work on trying to have legislative initiatives and change the discussion as best we can towards something that's friendlier for hospitals and healthcare.
- [21:23]
B
So well said. And you know, in putting everything into that right framework so that you can have the mindset to move forward is so hard. And like you said, keeping folks calm and having that understanding, I know a lot of that comes from the reassurance that there are those plans in place no matter what happens. But it can still be a huge, huge undertaking taking to create that message and that feeling, I think. Before we wrapped up here, I wanted to ask, where do you see some opportunities for additional growth as well, given the headwinds that we've talked about, given the current environment and uncertainties, how do you think about growth and what does that look like for you at Rush?
- [22:03]
A
I think it is as it was before. I think it's going to accelerate. I think it's getting care closer to patients. So while as important as the hospital is for higher acuity matters, more and more needs to be brought closer to patients. So I think that needs to happen. And as much as we're living in this digital world, being physically present, healthcare is one of those industries that you need in person personnel, you need in person services to be provided. And so you need to be as close as you can to patients for that. I think another thing that is coming up is the challenge of, of what to make sense of when it comes to AI. I guess Laura would be remiss if we didn't have a podcast where I didn't mention those two letters. But in reality, we do see a lot of people approaching us and other institutions looking towards AI for some measure of solution in healthcare, just like it is in a lot of other industries and making sense of that, understanding the risks better. I think we're all just kind of figuring it out and that is something that we'll have to pay attention to. But it also presents an opportunity for growth. So to tie into your growth Question meaning, can we do more with the same that we have? So using the people we have or less, you know, can we do more? Can we reach more patients? Can we do more for them with technological tools? It's possible. I'm very leery of AI. I am a skeptic, if not worse. But I also understand that it is, it is best form, like most technology, it can be used to help grow and help create efficiencies. And I would like to see where it can be done, where it can be used to do that. But basically it's that it's getting closer to patients, it's getting closer to them in person, and then from a more digital standpoint or a technological standpoint, figuring out these new tools that are being offered and making sure we understand them better and what their implications are for increasing. Maybe not growth per se, but, you know, if creating efficiencies and creating better ways of connecting with patients and doing more for them, them, but always staying pretty, you know, cautious on it when it comes to that. Because at the end of the day, healthcare is a human endeavor. I think patients want it to be not surprising. I know I do have a human being, whether it's in the form of nurse or a doctor helping us out. The care should be delivered by patients, excuse me, by people for patients. And we need to be focused on that. And so as impressive as some technologies can be, and we've seen them before, we are going to be dealing with humans and we need humans to take care of humans. And so that's what's going to be important.
- [24:45]
B
Absolutely, 100%. Carl, thank you so much for joining us on the podcast today. We covered a lot of ground looking at different policies, procedures, you know, best practices as well as now technology and AI and workforce shifts. So I appreciate your time and it's been such a great conversation. I'm also looking forward to, to seeing you in person at our annual meeting. I know you'll be speaking on a panel and we'll definitely be able to touch on some of these themes, dig a little bit deeper, and overall have the opportunity to connect further at that point. So looking forward to it and seeing you there.
- [25:18]
A
Laura, it was great to work with you today, talk with you today, and I look forward to seeing you at the meeting as well.