At Home & on the Hill

As the general counsel of BioScrip, Kathryn Stalmack has spearheaded an abundance of successful initiatives. The most important of which is perhaps her work with Congress to amend the 21st Century Cures Act.

Kathryn Stalmack, BioScrip

Kathryn Stalmack knew she was taking a leap of faith when she decided to take an in-house position with a $1 billion, publicly traded healthcare company. But she also knew that her determined work ethic and passion for healthcare would help her not only succeed in the face of a turnaround, but also find a way to make a difference.

“I was always laser-focused on leading by example to achieve the right results, whether it was at home or in the office,” Stalmack says. “I used my personal skills to connect with others and gain their trust and respect. My reputation is by far the most important thing I have. You don’t have to be the smartest person in a meeting, but you do have to listen, keep an open mind, and have good judgment in providing legal advice that serves the client’s best interest.”

Beyond learning how to become a sound decision-maker, moving into the corporate world gave Stalmack a new perspective on helping others do the same. “You have to know what resources you have to assist the company to make the right decision,” she says.

It’s a notion that has held true throughout her eighteen-year career, as well as in her work influencing policy. In fact, that ability ties closely to her decision to work in healthcare. If she was going to be able to wield that strength, doing so for the benefit of patients seemed to be the obvious route. Stalmack now uses that work ethic and focus throughout her career, leading to her current role as senior vice president, general counsel, and secretary of BioScrip.

Stalmack joined BioScrip in 2015 after eight years at one of the largest healthcare firms in the country, Polsinelli PC. In that position, she acted as outside counsel for BioScrip, among other responsibilities. When BioScrip’s CEO called to let her know that the then general counsel was planning on retiring, Stalmack knew she would want to step outside of her comfort zone and step into her first role as general counsel.

BioScrip is the largest independent national provider of home infusion services, operating across eighty service locations and with more than two thousand employees. In addition to the traditional legal focus of a general counsel, Stalmack extends her decision-making strength to act as a company-wide strategist. “I’m deeply involved in the company’s strategic initiatives and day-to-day business decisions,” she explains. “I want to help add value to our business model and focus on improving the patient’s experience to make us the number one infusion provider in the country.”

BioScrip functions, Stalmack explains, as a hospital without walls. As patients with illnesses come out of hospitals and return to their homes, BioScrip’s drugs and clinicians help them recover in their own homes rather than a hospital. “If a patient is very sick, say with a massive infection, then the riskiest, most expensive place for them to be to receive antibiotics is in a hospital,” she says. “We put them into the comfort of their own home, where it is also a tenth of the cost of a hospital stay. Plus, the data demonstrates that patients clinically do better at home. It’s where they want to be and where it’s the safest to be—period.”

In addition to helping improve the lives of many who rely on BioScrip’s services, Stalmack works closely with government officials in Washington, DC, in order to offer expert opinion on legislation and help influence education on the benefits of home infusion to members of Congress and Centers for Medicare and Medicaid Services (CMS). And that is always accomplished with an eye toward the needs of the patient.

A key example of that came when Stalmack worked closely on the 21st Century Cures Act and later changes to the law, which resulted in allowing critically ill patients to receive the life-sustaining drugs they need at home.

The Cures Act was signed into law in late 2016 and was designed to help promote innovation and accelerate medical product development. Among the roughly one thousand pages that encompassed the final bill, about fifteen pages involved the home infusion industry.

In those fifteen pages was language that had an unintended consequence of cutting the home infusion reimbursement rate—by nearly 95 percent—of certain medications intended for critically ill patients.

While it provided for a new services benefit to make up for the reduction, it would not go into effect until 2021. CMS historically never paid for the services benefit of home infusion, including all the clinical and other types of service that go into mixing the drug, packaging it, and delivering it to the patient’s home. The industry was also not allowed to bill CMS for the nursing services needed in the patient’s home, Stalmack says.

As a result, the Cures Act would make it unaffordable for the home infusion industry to treat those patients, and therefore, would keep them in the hospital. Those longer hospital stays would also cost Medicare millions of dollars. “It was devastating, and it devastated the home infusion industry,” Stalmack says. “But not only that, it also blocked patient access to care that cost less and provided them with better outcomes.”

Rather than recover comfortably in their own homes, heart surgery patients, for example, would need to go into hospice or have an invasive surgery when they could be having a home infusion of the drug. When these unintended consequences came to light, Stalmack and BioScrip’s CEO Daniel Greenleaf started a coalition with other home infusion companies and spent the following year attempting to change the legislation. “We hired the best lobbyist and outside counsel we could find to fight this important lifesaving initiative,” Stalmack says, adding that BioScrip retained Andrew McKechnie of Peck Madigan Jones and David Farber of King & Spalding. “Working with David and Andrew turned our nightmare into a dream come true when the industry was able to fix the legislation. We could not have done it without them, and for that, I will be eternally grateful.

“We were on the hill driving the impact of patient care home with members of Congress,” she continues. “Dan and I teamed up with the National Home Infusion Association and industry stakeholders, met with Congressional leadership, and spent time at fundraising events to educate Congress of the benefits of home infusion and that the federal government will end up paying more if the problem is not fixed.”

Stalmack and others also met with the CMS and brought with them a nurse who attended the first heart transplant in 1972, who explained why home infusion is better for the patient and saves the country millions, if not billions of dollars. “We had people all over the country lobbying,” Stalmack says, adding that the task was to bring a truly diverse and informed perspective of home infusion to politicians in order to do right by BioScrip’s patients. “Congress stepped up and got it done, and I am grateful for that. Our patients are grateful, and our industry is grateful.”

Kathryn Stalmack and her team at BioScrip worked with Congress on the Cures Act amendment.

After a concentrated campaign, the BioScrip leadership team helped lead Congress to amend the Cures Act so that it now provides for a transitional rate to bill CMS for the services benefit so that the industry can continue to care for those critically ill patients in the safest and most cost-effective site of care—their home.

“Not many attorneys get to say they took part in an effort that saved patients’ lives. But by getting Congress to pass the Cures Amendment in little over a year, I got to be a part of a very important campaign,” she says. “Hands down, it was the proudest achievement of my entire career.”

Despite that tremendous victory, Stalmack knows she cannot rest on her laurels. Congress has enacted the new benefit, but the work must continue to ensure CMS implements it correctly. Thankfully, Stalmack has a tireless commitment to helping her company and the patients they serve, and she won’t rest until the task is complete.

Photos: Wade Hiner

Kathryn is exactly the kind of client we love to work with at Peck Madigan Jones. She was proactive, strategic, and added immense value to our successful lobbying campaign.