Tara R Sklar

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Courses

Scholarly Contributions

Chapters

• Sklar, T. R. (2023). Health Law: Equity is Inextricably Linked to Health Care. In The Jurisprudential Legacy of Justice Ruth Bader Ginsburg. NYU Press.
• Sklar, T. R. (2024). Digitally Enabled Medicaid Home and Community-Based Services. In DIGITAL HEALTH CARE OUTSIDE OF TRADITIONAL CLINICAL SETTINGS. Cambridge University Press.
• Sklar, T. R. (2021). Workforce Development for an Aging Population. In Healthy Aging Through the Social Determinants of Health. American Public Health Association Press.

Journals/Publications

• Bathija, P., Krupinski, E. A., Rodriguez, J. A., & Sklar, T. (2023). Achieving Digital Health Equity by Personalizing the Patient Experience. Telemedicine Reports, 4(1), 166-173. doi:10.1089/tmr.2023.0018
• Milczarek-Desai, S., & Sklar, T. R. (2023). Immigrant Workers’ Voices as Catalysts for Reform in the Long-Term Care Industry. ARIZ. ST. L. J., 3(891), 891-949.
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  The COVID-19 pandemic exposed a long-term care crisis that has been brewing for decades. It also offered lessons for much-needed reform to the long-term care industry. One such lesson is that both older Americans and their caregivers experience unnecessary suffering and death due to entrenched industry practices that marginalize long-term care aides, a worker population that is increasingly made up of immigrant and migrant (“im/migrant”) women. Even though im/migrant women constitute at least one-third of the long-term care workforce, their perspectives are largely absent from the legal and public health literature and national conversations around long-term care reform. Indeed, to date, no systematic and comprehensive attempt has been made to collect and publish the lived experiences of im/migrant women who work as long-term care aides in the U.S. This Article is the first to use empirical data, collected by the authors through qualitative interviews of im/migrant aides in Arizona, to explore and analyze the failures of state and federal laws and policies, including Arizona’s paid sick leave law, to protect long-term care aides and the vulnerable, older, adult population that relies on their caregiving.The Article describes the use of critical race and health law theories to inform the study’s design and details the study’s methodology and findings. Through the voices of im/migrant women aides, the Article demonstrates that this subset of frontline, essential workers consistently experience violations of state and federal employment and labor laws and face significant barriers to accessing their workers’ rights, including paid sick time and protection from employer retaliation. The study’s findings show that im/migrant aides work in conditions that are unsafe not only for them but also for their patients. Together, these failures contribute to poor quality of care, chronic labor shortages, and increased potential for harm in future public health emergencies. The Article draws on im/migrant women’s voices to make recommendations for changes to laws and policies in Arizona and nationwide to help these workers and a rapidly growing, aging, American population. This research fills a critical gap in the literature regarding the shortcomings of workplace laws and healthcare policies in long-term care settings. It comes at a moment when the country’s long-term care system must be changed or face a crisis of epic proportions that will leave older adults and their loved ones with few, if any, options.
• Zawada,, S., Ruff, K., Sklar, T. R., & Demaerschalk., B. (2023). Addressing State-Based Barriers to Decentralized Clinical Trials. J. OF CLINICAL & TRANSLATIONAL SCI., 7(162), 4.
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  The challenge of adapting clinical trials to decentralized care models is increasingly pressing as virtual care becomes more common. In the United States, the patchwork of state and federal policies and regulations governing virtual care, such as limited interstate physician licensure, was a major barrier to the development of hybrid care models, blending in-person and telehealth, and the implementation of decentralized clinical trials (DCTs). During the COVID-19 Public Health Emergency (PHE), many states and the federal government enacted – often on a temporary basis – regulatory flexibilities to deliver care at home, including telehealth and remote monitoring, simultaneously empowering DCT models; however, the end of the PHE threatens to reverse leaps of progress achieved in the virtual care and DCT space during the pandemic. Given the growing provider shortage and related decreased access to care, it is imperative that DCT researchers design trials with a state policy-conscious lens to prioritize diverse participant enrollment and overall retention. Emerging work in this area demonstrates that engagement of patients, providers, and regulators in the design phase can identify barriers to DCTs. Thus, strategies to facilitate interdisciplinary collaboration and the translation of stakeholder perspectives into actionable policy recommendations are needed.Multiple existing frameworks are frequently employed to guide the process of identifying and addressing barriers to DCTs; however, none integrate perspectives from stakeholders across the translational spectrum. As DCTs are a relatively new mode of conducting clinical trials, there is a paucity of literature examining their implementation. Moreover, the research available is preliminary, restricted by the first DCT recorded in 2011. While some DCT research evaluates pharmacological agents, others focus on remote monitoring; regardless, DCTs are not limited by geographic restrictions, affording patients the option to participate from anywhere. Their scalable approach also has the potential to reduce patient burden, replacing in-person consults with telehealth, and improve the robustness of study data, capturing continuous in situ measurements using sensors. No published research has specifically examined the role of state policies in the implementation of DCTs that enroll patients residing in-state.We propose a novel conceptual framework to identify barriers to DCTs using stakeholder engagement that incorporates the broad perspectives of patients, their local providers, and state based policymakers. Through the discovery of barriers experienced by these groups, this framework integrates the dynamic experiences of key stakeholders across the translational spectrum to identify and address policies that hinder the conduct of DCTs. Unlike previous frameworks, this framework addresses the hurdle of nonuniform policy landscapes that modulate the scope and scale of DCTs on a state-by-state basis in the United States. CARE-P’s framework builds on previous DCT frameworks and is in the pilot implementation phase at Mayo Clinic.
• Sklar, T. R. (2021). The Return of Typhoid Mary? Immigrant Workers in Nursing Home. Journal of Elder Policy.
• Bismark, M., Moore, J. S., Sklar, T., & Taouk, Y. (2020).

  Vulnerability to legal misconduct: a profile of problem lawyers in Victoria, Australia

  . International Journal of the Legal Profession, 27(3), 269-289. doi:10.1080/09695958.2020.1751166
• Robertson, C. T., & Sklar, T. (2020).

  Telehealth for an Aging Population: How Can Law Influence Adoption Among Providers, Payors, and Patients?

  . American journal of law & medicine, 46(2-3), 311-324. doi:10.1177/0098858820933501
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  Telehealth continues to experience substantial investment, innovation, and unprecedented growth. However, telehealth has been slow to transform healthcare. Recent developments in telehealth technologies suggest great potential for chronic care management, mental health services, and care delivery in the home-all of which should be particularly impactful for an aging population with physical and cognitive limitations. While this alignment of technological capacity and market demand is promising, legal barriers remain for telehealth operators to scale up across large geographic areas. To better understand how federal and state law can be reformed to enable greater telehealth utilization, we review and extract lessons from (1) establishment of a healthcare relationship, (2) state licensure laws, and (3) reimbursement. We analyze these areas because of the legal ambiguities or inconsistencies they raise depending on the state, which seem to be hampering telehealth growth without necessarily improving quality of care. We propose several solutions for a more unified approach to telehealth regulation that incorporate core bioethics principles of doctor-patient relationship, competence, patient autonomy, as well as population-wide questions of resource allocation and access. Lawmakers should clarify that healthcare relationships may be established outside of in-person meetings, align licensure laws via an interstate compact or federal preemption, and expand Centers for Medicare and Medicaid plans to reimburse telehealth delivery in the home.
• Robertson, C., & Sklar, T. (2019).

  Affordability Boards — The States’ New Fix for Drug Pricing

  . New England Journal of Medicine, 381(14), 1301-1303. doi:10.1056/nejmp1906010

Presentations

• Sklar, T. R. (2024). Advancing Virtual Care Practices Across the Cognitive Impairment Continuum. 2024 Arizona Bioethics Network Annual Conference on Chasing InnovationArizona Bioethics Network and Mayo Clinic.
• Sklar, T. R. (2024). Advancing Virtual Care Practices Across the Cognitive Impairment Continuum. 2024 Case Western Reserve University’s Cognitive Decline and the Law ConferenceCase Western Reserve University School of Law.
• Sklar, T. R. (2024). Closing Care Gaps Through Telehealth Policy and Broadband Access. 2024 Arizona Rural & Public Health Policy Forum. Phoenix: Center for Rural Health.
• Sklar, T. R. (2024). Immigrant Workers’ Voices as Catalysts for Reform in the Long-Term Care Industry. 2024 AALS Annual Conference Section on Law, Medicine, and Health Care Main Program. Washington DC: Association of American Law Schools.
• Sklar, T. R. (2024). Telehealth Year in Review: State and Federal Policy Updates. 2024 Arizona Society for Healthcare Attorneys Annual Conference. Phoenix: Arizona Society for Healthcare Attorneys.