Legal Training Makes a Difference for Health-care CFO

He can't practice law, but he spent 30 to 40 hours a week for three years learning how to "think like an attorney" — and it was well worth it, he s...
David McCannMarch 5, 2019
Legal Training Makes a Difference for Health-care CFO

Almost anyone could get a career boost, as well as benefit their employer, through continuing education. It holds true even for top executives.

But “continuing education” can mean anything from an online personal enrichment course to rigorous multi-year training programs. While most executives could find time for the former, few could for the latter.

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Among those few is Alex Bauer, CFO of Sansum Clinic, a nonprofit out-patient medical facility in Santa Barbara, Calif., with just over 1,000 employees. In 2015 he enrolled in a three-year online “executive juris doctorate” (EJD) degree program offered by Concord Law School, an affiliate of Purdue University.

Graduates of the program can’t practice law, but as students they acquire much of the same knowledge that aspiring attorneys do — and that requires considerable time and effort. Bauer, who graduated from the EJD program at a ceremony on Feb. 28, says he routinely put in 30 to 40 hours per week in pursuit of his goal.

Alex Bauer

How does a CFO find time for that? In Bauer’s case, he got up at 4:00 a.m. to study, went to work at his job at 7:00, and then picked up the legal studies again from about 6:30 or 7:00 p.m. until 10:00. And weekends were “full bore.”

Even vacations weren’t sacrosanct. Embarking on a Bahamian cruise with his family, Bauer wheeled a roller bag loaded with his law books onto the ship, drawing more than a little attention.

“There’s no family time,” he says. “And my family would attest to that.”

In his mid-40s, Bauer is no kid. His CV sports almost 20 years of finance experience, mostly within the medical field. He already had a CPA certification and an MBA degree. What motivated him to shoulder the massive new educational load?

According to Bauer, he simply wanted to be better at his job. With health care being a highly regulated and litigious field, executives of medical facilities are in contact with lawyers almost daily — which can be problematic.

“Attorneys have a hard time understanding the operational realities of medicine,” he says. “In large part it’s a language thing.”

For example, there’s a medical billing term called “practice supervision.” Certain procedures can be billed only if they were supervised by a physician. There are several types of supervision, each with its own legal definition.

“However, the realities of practice supervision at a medical clinic don’t neatly adhere to the legal definitions,” Bauer says. “It can be difficult for attorneys to make a connection between those definitions and what’s practical and real in an operational sense.

“Now,” he continues, “as someone who is experienced in operating medical clinics and also has been trained to think like an attorney, I’m able to build bridges between the clinic operators and outside legal counsel or regulators.”

The EJD training also has helped Bauer in the area of contract negotiations and management. He now has a much better understanding of contractual elements and the specific purposes and implications of certain clauses.

“I understand why the other party has added a certain clause, and I can use that understanding as leverage to get something else I want,” he notes.

The idea of getting legal training first came to Bauer when he was with a prior employer that operated outpatient radiological imaging facilities.

The federal Centers for Medicare & Medicaid Services has different billing rules for different types of imaging facilities. Bauer’s employer received a notice in which CMS questioned the clinic’s entrenched billing procedure for a certain type of imaging. The clinic was potentially on the hook for refunding CMS payments totaling several million dollars.

Specifically, CMS alleged, because the imaging sites in question were owned by a medical group affiliated with a hospital system, the sites were of a “hospital-outpatient” type.

“Outside counsel believed that to be true without considering the possibility that the medical group, even though affiliated with a hospital, operated and licensed its imaging sites as ‘provider-based or independent’ diagnostic testing facilities,” Bauer recalls. Moreover, the medical group did not employ its own radiologists but rather contracted with an unaffiliated radiology medical group to perform and supervise services.

Ultimately Bauer realized that outside counsel had failed to pick up on such important nuances, but not before the clinic suffered needless costs and other hassles.

“If I had understood how attorneys thought, I could have saved my employer thousands in legal fees and lots of headaches over the looming threat of having to pay millions of dollars back to CMS,” he says.

There was another positive result of earning the EJD degree that Bauer hadn’t foreseen. “From a marketability standpoint, the number of inquiries I’m getting from recruiters and others is noticeably higher,” he says.

Although Concord Law School offers online education only, it’s headquarters is necessarily in California, the only state in the country that allows attorneys who received their degree through an online program to sit for the bar exam.

From 2002 through 2018, Concord graduated 867 EJD students, about 10% of whom were finance professionals, although only a smattering were CFOs.

However, notes Concord law professor James Dodge, “If you have a good understanding of finance, you’re well prepared for this. You have discipline and understand how to make logical connections. The finance professionals I teach aren’t afraid to show you all the steps in their reasoning process.”

The coursework for the first year of the EJD program is identical in both scope and difficulty to what law school students experience, according to Dodge. The next two years actually provide EJD participants with much greater flexibility in choosing courses than those studying to become attorneys have, he notes.

For Bauer, the effort expended — as well as the cost; he paid for the legal training himself — were unquestionably worthwhile. “Obviously it’s a personal decision, but for me it absolutely made sense. I’m the clinic’s sole contracts person now, and we don’t have an internal general counsel.”

He adds that he highly enjoyed the legal training. However, it came at a cost for such a well-educated person: “When it was done, I had to promise my family: No more education.”