Lawyers at Seton Healthcare Family in Austin have been busy since the federal government enacted major healthcare reforms, and general counsel Teresa Burroff is excited about the changes.

Her team’s legal services are in high demand as the Affordable Care Act has affected Seton by bringing a wave of “innovation,” says Burroff, senior vice president of legal affairs and general counsel of the Catholic-affiliated nonprofit organization. Seton annually provides $300 million in charity healthcare.

Among other changes brought about by the new law, Seton is one of 30 healthcare providers nationwide testing a new healthcare model, the Accountable Care Organization (ACO). Many laws come into play when creating a new healthcare model, and Burroff says dealing with the “unknown” is the most challenging legal aspect of facilitating the innovation.

“The law has changed and the law is changing, literally, as you develop each new healthcare model,” says Burroff. She adds it’s time intensive “trying to make sure you navigate around what is currently the law, versus what you know the law will get changed to.”

She explains that ACO attempts to gather all of a person’s care — such as primary doctors, specialists and hospital care — under one “umbrella” meant to manage a person’s long-term health more efficiently. Some of the laws that come into play regulate how hospitals can refer business to doctors and how patients give consent for sharing their medical records.

Burroff earned an undergraduate degree in accounting from Northeast Louisiana University in Monroe in 1982. She then earned her law degree from Texas Tech University School of Law in 1984, graduating early by taking extra classes each semester.

Burroff worked as a tax-law associate at Brown, Maroney, Rose, Barber & Dye in Austin from 1985 to 1987. She then practiced as an associate at Milgrim, Thomajan & Lee in New York City from 1987 to 1988. The firm had an international-tax practice that attracted Burroff, and she had always wanted to practice in New York, she says.

Returning to Austin, Burroff became a tax staff attorney at The University of Texas System from 1989 to 1998. She says she went in-house because she and her husband expected a baby, and Burroff wanted a more dependable work schedule.

In 1990, Burroff earned a master’s of business administration from The University of Texas at Austin. She also completed coursework in 1998 to earn a Ph.D. from UT-Austin, but life’s rhythms have prevented her from completing her dissertation.

She left the UT System in 1998 when an opportunity arose to become a senior attorney at Samsung Austin Semiconductor; two years later Samsung promoted her to general counsel.

Burroff then joined Seton as general counsel in 2007. She spends much of her time providing legal guidance and contributing ideas to Seton’s board of directors and leadership team. Burroff also supervises five lawyers who serve different areas of Seton’s operations.

One Seton lawyer serves the organization’s insurance services department, which manages relationships among insurance companies, physicians and Seton facilities, among other things. Another attorney helps do background research and draft employment contracts in the hiring process for new doctors and physician groups.

Burroff says because laws and regulations touch nearly every aspect of the healthcare industry, one lawyer is devoted to overseeing compliance at Seton’s 10 acute-care hospitals and one mental health facility, and the rest of Seton’s lawyers pitch in to help. They take turns being on call for 24 hours so hospital staff can get legal guidance for unique patient situations. For example, the parent of a hospitalized child may complain her ex-spouse cannot be near the child because it’s not his visitation week.

Burroff’s department negotiates and drafts contracts and establishes policies to facilitate an agreement between Seton and UT Southwestern Medical Center in Dallas. Seton employs and pays teaching physicians and UT Southwestern medical-student residents in its hospitals. Burroff explains Seton hopes the effort will lead to the establishment of an Austin medical school, which could attract more doctors to serve the community.

One in-house attorney assists Seton with corporate governance work and helps negotiate mergers and acquisitions. For example, Seton has a long-term contract with the Travis County Hospital District to operate University Medical Center Brackenridge, the only Level 1 Trauma Center serving Central Texas.

Burroff says she also supervises outside counsel who handle litigation against Seton, typically in the areas of medical malpractice, general liability and employment. She is personally involved in efforts to create a Seton patent portfolio for medical inventions, and she enjoys working on agreements for community outreach projects like a childhood-diabetes initiative that merges nutrition, exercise and educational services.

Jody Scheske, partner in charge of the Austin office of Akin Gump Strauss Hauer & Feld, says during the time he’s worked as outside counsel with Burroff, he’s come to know her as an intelligent and engaging person who is knowledgeable about many areas of the law because she’s worked in multiple industries.

“You know when you’re getting a request from her, it’s going to be something interesting, and something she’ll want to work with you on,” he says.

Fulbright & Jaworski partner Jerry Bell, who works with Burroff on healthcare matters, says Burroff has high performance expectations for outside counsel. All her efforts are “wholly committed” to Seton’s mission and values, and Burroff makes clear to outside counsel she expects them to do the right thing, says Bell.

“That’s a great position for the outside counsel. You don’t worry about the fallout. You’re doing what’s best and right for the institution,” he says.

Burroff recalls she was happy as Samsung’s general counsel, but Seton’s mission to provide healthcare for the poor and vulnerable and support the community attracted her to join the nonprofit.

“It’s hard to imagine working for a place that’s more inspirational,” she says, adding, “This place, you get up and go … ‘I can make a difference in a person’s life, and I want to go to work.’”

Best Practices: Preparing for Change

Teresa Burroff, senior vice president of legal affairs and general counsel of Seton Healthcare Family in Austin, says she never planned to leave her previous position as general counsel of Samsung Austin Semiconductor. But she couldn’t pass up the opportunity to work toward Seton’s mission of providing healthcare for the poor and vulnerable and supporting the community.

Texas Lawyer reporter Angela Morris emailed Burroff some questions about her background and Seton’s use of outside counsel. Here are her answers, edited for style and length.

Texas Lawyer: Which things from your previous legal experience help you most on the job today?

Teresa Burroff: The ability to recognize and reward creativity regardless of the final outcome.

TL: What’s a significant way that federal healthcare-reform efforts have impacted Seton and your legal department?

Burroff: Regardless of the outcome of the U.S. Supreme Court decision on the Affordable Care Act, healthcare has changed. The focus is on long-term patient outcomes and how reforms can create an environment to enhance the quality and safety of healthcare. This has changed the affiliations and how providers are paid, which necessitates the redrafting of many agreements. Change is our new constant, so as a legal department, we have to be flexible and be able to quickly adapt as the laws continue to evolve in the healthcare arena.

TL: For what types of legal work does Seton typically hire outside counsel?

Burroff: We typically hire outside counsel for litigation, real estate issues and major-transaction work.

TL: What are the biggest factors you consider when hiring outside counsel?

Burroff: Quality of work and the ability to partner with us as we navigate through a legal issue.

TL: What can outside counsel do to perform beyond your expectations?

Burroff: It would be nice for an annual review to come from outside counsel on what we could jointly do to reduce costs. Our outside counsels ask for and receive feedback on performance, but I would also like to know as a client, how could our internal interactions be improved to reduce costs.

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