The healthcare enterprise risk approach takes compliance in new directions
Featured speakers: James Bryant, Vice President and Chief Compliance Officer, Brigham and Women’s Hospital; Timothy C. Hogan, Senior Vice President and Chief Compliance Officer, Boston Children’s Hospital; and Renee Wroth, Vice President and Chief Compliance and Privacy Officer, Baystate Health. Moderated by Lawrence W. Vernaglia, Foley & Lardner.
Bryant, Hogan, and Wroth addressed the Massachusetts Health and Hospital Association’s Healthcare Legal Compliance forum in December 2022. They spoke about going beyond historical healthcare compliance duties like billing coding to include
- A strategic approach to improve compliance rates in the context of internal business challenges
- A mission-based approach to nondiscrimination and access to care for individuals with disabilities and limited English proficiency
- Efforts to address the increased enforcement across controlled substances and diversion monitoring plus complying with best practices and protecting patients in 340B programs
This recap of their remarks looks at how to connect with colleagues, shoring up institutional knowledge, and connecting compliance to patient care.
Simplifying Compliance for Burned-Out Colleagues
Before diving into specific compliance issues, the panel shared insights on how they are developing empathy and care for their colleagues. They are thinking about human issues before compliance issues. Hogan referenced the social determinants of health and said there are also social determinants of compliance.
That is, people want to be healthy – and compliant –but there are countless factors outside of what healthcare leaders can directly influence. For health that might include home environment, food security, or income security. If you want to improve health outcomes you have to improve the social determinants of health as well.
Just like people wanting to be healthy, people also want to do the right thing. But there are barriers a Compliance team can’t control, like burnout, staffing shortages, and upgrades to clinical data systems for instance. Hogan said if he wants to improve compliance rates, he has to be sensitive to the workload his colleagues already face. What he’s asking for is additive to that, and usually it’s never one thing he needs them to do, it’s many things. That means that while no one individual thing is a heavy lift, all of them together can be disruptive and feel impossible. He focuses on making his requirements and requests as simple as possible and aligning them to clinical care.
Loss of Institutional Knowledge
Bryant and Wroth both said they worry about rapid turnover of staff and loss of institutional knowledge, both in Compliance and throughout the organization. Compliance officers find that their go-to colleagues have left or changed positions.
Turnover, burnout, and hybrid work environments have all led Wroth to believe compliance professionals have to rethink their strategies for reaching people. Without in-person training or long-tenured staff, there can be a significant loss of institutional knowledge that challenges compliance rates.
To retain the institutional knowledge, she has started meeting with leaders before they leave to get critical information that she can pass on to the next leader. She’s asking her team, “What do we need to do? How can we step in to make sure that there’s that transfer knowledge?”
Connecting with Colleagues in a Hybrid Work Environment
All the panelists noted that remote meetings aren’t going anywhere, even though most healthcare professionals are working in person. Bryant noted that it’s harder to get side conversations going on Zoom because people can’t pull you aside for a quick clarification break. Hogan said he counteracts this by opening meetings a few minutes early and being the last one to leave a call. That way he can connect informally with others. This practice has led to some great conversations and follow up emails.
Wroth said her team feels more visible with the use of Zoom. Before they felt like faceless voices on the phone, unable to meet with colleagues across the health system regularly. Now that everyone is used to Zoom, she sees that people know the team’s faces and makes better connections when they meet with colleagues.
Connecting Compliance to Patient Care
The panel gave examples of current compliance issues and how to position them in relation to patient care. For instance, Wroth is “addressing compliance with Sections 1557 and 504, as well as the ADA. Those laws ensure effective access for people with disabilities, including effective communication for people with hearing loss. She wants to make sure the front line recognizes and conveys the message when there’s so much on their plate. When she talks about this issue she ties it back to the hospital’s mission, which is “To improve the health of the people in our communities every day, with quality and compassion.” In this context, it’s easy to see that effective communication – getting translators or sign language support – is the right thing to do for the health of the community.
Telehealth is another area that supports better patient care and carries regulatory complexity for the program overall and for ADA compliance. Wroth works with a steering committee of operational leaders who own the program. She gives them all the information she can and then supports them as they manage the program in a compliant way.
Hogan said that even though Compliance officers aren’t delivering care, they are connected to effective care. They can always make sure the appropriate leader has been defined and supported to improve the delivery of care. According to Hogan, sometimes the most important role Compliance can play is not owning the issue but making sure the conversations are taking place.
“I can’t fix the issue of getting interpreters in the middle of the night. But I can make sure the conversations are taking place and documenting what is happening so we see the gaps and can fill them.” – Timothy C. Hogan, Senior Vice President and Chief Compliance Officer, Boston Children’s Hospital.
Bryant agreed that being there to ask the right questions of the right people and prompting them to consider requirements as they build their programs. For instance, both the ADA and 1557 require that there be a coordinator to field complaints. As you’re dealing with turnover in your organization, you can help leaders be sure that roles like this stay filled. It’s incredibly helpful to your colleagues.
What Else Is on Your Desk?
Wroth is looking at Covid funding, including provider relief fund audits and implementation of HHS programs.
Bryant is addressing an uptick in Medicare auditing, recovery audits and NGS locally. Some of the audits have focused on the use of treatment plans in certain areas, like inpatient, group, and individual psychotherapy claims; and cardiac rehab.
Hogan is facing audits from private payors, including prepayment reviews. He said he is seeing claims held up because the system flags a potential data issue. The data analysis tools are still new and flag a lot of false positives, so he’s having to work extra hard to get legitimate claims paid.
Recaps From The 2022 Massachusetts Health and Hospital Association’s Healthcare Legal Compliance Forum
YouCompli sponsored MHA’s 2022 Healthcare Legal Compliance Forum. To access the full session recording, please contact the Massachusetts Health and Hospital Association.
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- Federal and State Agencies Preview 2023 Enforcement Trends
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