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Marquis Of Holland
When John Marquis stepped down as chair of the Health Law Practice Group at Warner Norcross & Judd LLP 15 years ago, the health care field was a much less complicated world.
The way medicine is practiced today has changed dramatically at all levels. The historical model of a hospital with associated private practice physicians is fast becoming obsolete. Hospitals have taken to hiring their own physicians and specialists, while private physicians specializing in hospital care, known as hospitalists, are replacing primary care physicians in the hospital. Research centers such as the Van Andel Institute and the various profit and nonprofit research programs conducted internally and externally are a relatively new phenomenon, at least locally.
With no Stark laws or HIPAA regulations, the regulatory environment was far easier to navigate.
“Internally and externally, health law has changed dramatically,” said Marquis, who specializes in health law, tax and related legal issues. “You need to have a deeper expertise today. A lot of these regulations didn’t exist 20 years ago; now you can barely move without keeping an eye on them.”
A good example are the Stark laws, three separate provisions of federal law governing physician self-referral for Medicare and Medicaid patients. While barely understood by many health care workers and the general public, the Stark laws have heavily influenced hospital-physician relationships — making an already complicated Medicare system all but impenetrable. Other regulations, such as the Health Insurance Portability and Accountability Act, have put similar restraints on the sharing of information and the use of technology.
“And from a demand standpoint, it’s growing rapidly,” said Marquis. “So not only do you need people with a particular knowledge, you need more of those people.”
When Marquis first began working in health law, the most complicated cases he would see involved fairly standard employer-employee relationship concerns. This was 1972, when the 27-year-old attorney began representing Holland Hospital. A Holland transplant, Marquis had relocated with his wife, Carolyn, from Columbus, Ohio, two years earlier, disenchanted with his daily commute into the city. The couple only had one vehicle at the time, so the young lawyer took the bus to work. An offer from the Holland firm that is today Cunningham Dalman PC was a welcome alternative.
Cunningham Dalman was counsel to the city of Holland, a role it holds to this day. At the time, Holland Hospital was owned and operated by the city, and its counsel needs fell to the junior attorney. Over the next 35 years, the hospital converted to an authority charter and later into a private nonprofit, with its legal needs becoming increasingly sophisticated with each passing year.
In 1990, Marquis became the first and only partner in the Holland office of Grand Rapids-based law firm Warner Norcross & Judd. It has since grown to nine members.
“I felt that joining Warner was a very, very positive decision,” Marquis said. “It sounds self-serving, but I don’t intend it that way. There is a culture here that is very unusual for law firms in how we relate to one another and how we deal with internal issues.”
Through the early 1990s, Marquis served as chair of the health law group, establishing programs and standards that helped the group grow to 20 members and a national footprint. This summer, Marquis assumed that role again when Grand Rapids partner Devin Schindler stepped down because of time constraints in his practice and professorship at Thomas M. Cooley Law School.
On the national level, Marquis has become perhaps the best known attorney in the development of a new wrinkle in the medical landscape: concierge medicine. Concierge medicine is a primary care practice in which patients pay the physician a yearly or periodic sum, either as a retainer or full payment, for increased access to care. The arrangement allows physicians to shrink their practices dramatically — from 2,500 patients to 500, hypothetically — allowing them to spend more time with each patient. Such a practice is also under much less financial pressure than a standard practice, as it is not subject to the whims of insurance companies or Medicare.
“An internal medicine doctor today is seeing more patients than she was five years ago, but earning less,” explained Marquis, who represents concierge practices across the U.S. “Every time Medicare reimbursement shrinks, I start getting calls.”
When Medicare reimbursements are decreased, physicians are forced to take on more patients to meet overhead costs. The result is a harried schedule that may mean a seven-day work week. Concierge medicine allows physicians an alternative.
“This whole practice would be wiped out if the government were to increase Medicare payments,” Marquis said.
Concierge practices are most common in areas where there are large numbers of individuals with significant wealth and health care utilization, such as the affluent retirees of Florida, Arizona and southern California. For this reason, the practices have been criticized by medical ethicists fearing decreased access to health care as doctors cater to the wealthy. But ironically, a parallel version of the concierge practice has developed, as programs in Washington and West Virginia have emerged that cater exclusively to the poor.
“I have a client in Seattle whose average monthly fee is $64 to $75 a month, and for that you can buy all your family’s primary care,” said Marquis. “It’s not supposed to take the place of insurance, but for those without insurance, it’s affordable preventative care. You can afford to go the doctor once or twice before you’re sick, instead of going five times after you’re sick.”
Marquis was first introduced to the concept through his work in Medicare consulting. Although much more complicated than it sounds, the legal crux of most concierge programs is that a physician must opt out of the Medicare program. In 2003, Marquis co-founded The Society of Innovative Medical Practice Design, a nonprofit organization devoted to the needs of concierge medicine and other innovative medical practices.
In the coming years, Marquis expects the health care field to become even more complicated.
“There is momentum at the national level for some type of health care reform,” he said. “Whatever shape that might take, it’s going to become a particular subject in the upcoming presidential election.
“Every time — and this is not a slander against the government — but every time the federal government takes a step in the health care arena, it gets complicated — and it affects everyone.”
An active figure in the Holland community, Marquis volunteers his time to many local organizations and boards. He is currently president of the Community Foundation of the Holland/Zeeland Area and founding chair of Lakeshore Advantage.
“I think this is an example of something very unusual for western Michigan,” said Marquis of Lakeshore Advantage, an economic development group. “You look around and see things that have happened because there were a lot of community-minded people with the spirit to do something. Traditionally, Holland has been on the receiving end of good economic news, and as soon as it started to turn, people started to work toward a more organized economic development effort.”
“We want companies to know that we love you when you come here, when you’re here and when you leave,” Marquis said. “These companies employ our people and pump millions and millions into our local economy. When they leave, we have to make the best of it. We don’t have to like it, but it’s a business decision, and you can’t be angry about their deciding to leave.” LQX