Stakeholder relationships and standard regulatory change management processes are critical for effective healthcare compliance
Continue readingEstablishing a regulatory change management process for healthcare
Telehealth expansion: Interstate licensure compacts benefit patients
Telehealth services and models have expanded rapidly during the pandemic. Healthcare employee burnout, the Great Resignation, and other factors are expected to further accelerate telehealth growth.
Telehealth expansion has led to significant growth in the use of interstate licensure compacts. As more healthcare professionals obtain licensure under compacts, compliance officers need to be aware of interstate licensure requirements – and their effects on patient care.
Increasing use of interstate licensure compacts
The National Council of State Boards of Nursing (NCSBN) recently published its annual report on interstate licensure. It noted 43 states and territories have enacted licensure compacts for nurses, physicians, physical therapists, emergency medical technicians, psychologists, speech therapists/audiologists, occupational therapists, and counselors.
The Nurse Licensure Compact (NLC) is an interstate agreement allowing nurses to practice in multiple states with one multistate license issued from their home state. The compact enables nurses to provide nursing services to patients located in other NLC states via telehealth without obtaining additional licenses. The NCSBN says this approach allows for greater nurse mobility, public protection, and access to care.
In addition, use of the Interstate Medical Licensure Compact (IMLC) grew by 47% in the past two years. The IMLC Commission noted “more than 8,000 licenses were issued through the compact from March 2020 to March 2021.” This is compared with nearly 4,000 licenses issued during the previous 12-month period.
With more healthcare professionals practicing across state lines, patients have more choices. And healthcare compliance officers have processes and procedures to update.
Interstate licensure compacts benefit patients
For patients, one benefit of licensure compacts includes licensing boards being able to ensure that physicians maintain professional integrity and medical standards – regardless of where they practice. As more healthcare professionals obtain licensure under compacts, patients gain greater flexibility in making care decisions.
For example, rural patients can participate in a telehealth visit with a specialist or provider at home. This saves patients the time and expense of driving long distances to see the same provider in a facility setting.
Another positive is the increased use of remote monitoring devices, such as glucose monitors, blood pressure monitors, and heart monitors. Patients can receive state-of-the-art monitoring remotely, instead of as a hospital inpatient. In turn, healthcare costs decrease and patient compliance increases.
A significant patient benefit with expanded telehealth is the inclusion of mental health services. Under the provisions of the Consolidated Appropriations Act of 2021, services for the diagnosis, evaluation, or treatment of mental health disorders may continue as telehealth services. Per the Centers for Medicaid & Medicare Services (CMS), the previous restrictions limiting telehealth mental health services to patients residing in rural areas no longer apply.
Compliance considerations
Compliance officers need to help their organizations keep up as healthcare delivery models change. Organizations will need to update everything from billing codes to human resources policies and procedures to information technology (IT) practices.
For example, compliance officers should partner with Human Resources to make sure out-of-state licensed professionals have been educated in facility policies and procedures. They also need to ensure that professionals working under licensure compacts understand the nuances of the rules and laws in the state they are working.
Compliance officers also need to work with the IT department to ensure that remote devices have been securely connected to the network. They also need to collaborate with the risk department on making sure proper medical professional liability insurance coverage has been obtained for these licensed professionals.
Compliance officers should work with Revenue Cycle on two crucial issues:
- Ensuring that the organization stays abreast of the changes to the CMS list of services payable under the Medicare Physician Fee Schedule when furnished via telehealth.
- Staying current on telehealth visit coverages and coding modifiers to decrease denials of patient charges.
As your team manages your response to continuing regulatory changes, having a system to keep up with the moving parts can help. YouCompli can support your regulatory change management process. It provides regulatory analysis to help you know what changes are coming and decide whether they affect your institution. It also provides requirements, tasks, and deadlines, in clear business English, making it easier for you to manage changes and verify that you’ve taken the proper steps.
Denise Atwood, RN, JD, CPHRM
District Medical Group (DMG), Inc., Chief Risk Officer and Denise Atwood, PLLC
Disclaimer: The opinions expressed in this article or blog are the author’s and do not represent the opinions of DMG.
Denise Atwood, RN, JD, CPHRM has over 30 years of healthcare experience in compliance, risk management, quality, and clinical areas. She is also a published author and educator on risk, compliance, medical-legal and ethics issues. She is currently the Chief Risk Officer and Associate General Counsel at a nonprofit, multispecialty provider group in Phoenix, Arizona and Vice President of the company’s self-insurance captive.
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Continue readingFor Hospitals, Climate Change Compliance Pays. Literally.
Hospitals nationwide are trying to recover from what AHA president Rick Pollack calls a “triple whammy.” Between “increased expenses incurred in…caring for the COVID patients,” “the decreased revenues” from “having shut down regular operations in terms of scheduled procedures,” and “the increased number of uninsured,” it’s probably no surprise that, according to AHA estimates, US hospitals are losing as much as $50 billion a month.
What is surprising, though, is how hospitals are offsetting some of those losses — to the tune of tens or hundreds of thousands of dollars a year — with significant savings from climate change sustainability. In principle, this boils down to cutting waste — wasted food, wasted paper, red bag waste, wasted electricity — and associated disposal costs.
Climate change regulations are complex, and are likely to change over time, as climate change becomes a more serious issue for regulators. Establishing a program now that fits within existing regulations, has potential to grow, and will support the hospital’s budget needs — all without violating other compliance requirements — is a significant win for compliance professionals.
As these examples show, there are opportunities now to reduce your climate risk, save money, and stay compliant:
Reduced Consumption
- In Wisconsin, Gundersen Health System reduced food waste by more than 80%, saving more than $150,000 over five years.
- They also found that cutting electricity waste was as easy as changing a light bulb – actually, lots of light bulbs. Retrofitting six buildings’ light fixtures cut electric bills in half, saving 4.4 million KwH and about $265,000 a year. And those are only the direct savings. Replacing incandescent bulbs or CFLs with LEDs produces highly directional lighting. They use 75% less energy and last 25 times longer. They also cut air conditioning costs, because while incandescents give off 90% of their energy as heat, and fluorescents about 80%, LEDs give off next to none.
- Ascension Healthcare saved $53.3 million over 7½ years by reducing energy use in its 141 healthcare facilities in 20 states.
- When Minnesota-based Health Partners went paperless in 2014, their more than 90 hospitals and clinics cut paper use by 8% and saved more than $700,000 over three years. (Before you follow their example, though, you should know which paperwork can go digital and which must be filed in hard copy to comply with federal and state regulations.)
- In Olympia, Washington, Providence St. Peter Hospital decreased water consumption by 58%, saving a total of $2,510,479 on water. What’s more, they earned another $1 million in utility rebates under a state water reduction incentive program. Accomplishing this was as simple as finding and fixing leaks, replacing single-pass refrigeration units, calling a vendor to turn off an unneeded cooling pipe, and installing dual-flush toilets and slowing sinks’ faucet speeds in 165 patient rooms.
- By cutting energy consumption by 23% per square foot in its 12 hospitals and almost 400 sites of care, Advocate Health Care saved $23 million over seven years. And by reprocessing instead of discarding medical devices, they save another $2.1 million annually.
ORs and Medical Waste
- ORs account for 20-30% of a hospital’s total waste, up to 60% of its medical waste, and about a third of its expenses. By lowering the number of air exchanges per hour (ACH) from 25 to 20 (the federal and state required minimum) between surgical procedures, the Cleveland Clinic saves $250,000 a year.
- Health Partners’ waste reduction and recycling program has diverted 793,000 pounds from the ORs of all its hospitals.
- By removing 91,753 pounds of instruments from the reprocessing cycle, Dartmouth Hitchcock Medical Center saved almost $1.5 million.
- Seattle’s Virginia Mason Medical Center cut supply costs by over $3 million in three years by switching to reprocessed medical devices.
Implications for Compliance
Selling these savings to the executive board is easy. Savings like these don’t just go once to your bottom line. They stay there, year after year. What’s more, they can increase your property value by as much as eight times your investment. Reducing energy use can also earn you federal tax reductions and refunds, state matching grants, and electric utility rebates.
From a compliance standpoint, the obvious concern is whether implementing these changes to green your organization will have negative impacts on your exposure to compliance risk. And that’s a big challenge to overcome. What you need is a way get clear insight into what regulations require, and what environmentally-focused options are available.
The New Office of Burden Reduction and Health Informatics: Implications for Healthcare Compliance
You may have heard that, last week, the Centers for Medicare & Medicaid Services (CMS) announced the creation of a new office: the “Office of Burden Reduction and Health Informatics.”
What exactly is this new office supposed to do? According to the press release from CMS, the intent is “to unify the agency’s efforts to reduce regulatory and administrative burden and to further the goal of putting patients first.”
All well and good. But what does that actually mean?
Value-Based Care
Here’s one thing that CMS says clearly. They are “committed to leveraging the significant flexibilities introduced in response to the COVID-19 pandemic as we continue to lead the rapid transformation to value-based healthcare.”
We’ve all been hearing about value-based care for years. (Here’s a piece from 2016, for example.) The pace of change hasn’t been particularly speedy, and the pandemic has disrupted most big transformative plans, especially in healthcare.
That said, the Department of Health and Human Services (HHS) is still committed to value-based care. If reducing or streamlining the regulatory environment is necessary in order to make this change happen, you can bet that HHS and CMS will do it.
What specific regulations will CMS change in order to make this happen? That remains to be seen. Recently, CMS did announce that they will be maintaining at least some of the regulatory changes related to telehealth.
Which ones? We know of one rule change that CMS has announced: the proposed physician fee schedule rule, which should come out in July, will include proposals to permanently expand coverage for telehealth services. As of this writing, the rule has not been published, and CMS has not announced details.
With that exception, however, there hasn’t been a lot of movement on specific regulations that could be helpful. In fact, our observations suggest that most regulators are moving back to business as usual. If CMS has plans to streamline regulations to enable the transformation to value-based care, they are keeping those plans very close to the vest.
Improved Review
However, CMS commits clearly to increasing the number of stakeholders – including clinicians, providers and health plans – that it engages with when assessing the impact of new regulations.
This could be a welcome change for compliance professionals, as a more comprehensive assessment of regulatory impact could result in a regulatory environment that’s a lot easier to work within. Clearer regs with reduced expectations would mean less work required by the clinical and revenue cycle staff in your organization.
And that would mean less time spent following up and trying to get staff to do the work.
Health Informatics
CMS has also committed – as indicated in the second half of the new office’s name – to further implement health informatics. The idea here is to effectively use health data in order to provide better care.
CMS gives this as a specific example: “to create new tools that allow patients to own and carry their personal health data with them seamlessly, privately, and securely throughout the health care system.”
This proposal has obvious advantages for both patients and providers. But it could cause significant headaches for compliance.
Staying in compliance with an EHR system for just one health system is challenging enough. What CMS is proposing is an EHR system that applies across all Medicare and Medicaid beneficiaries. This would be much more complicated! The HIPAA implications alone could be staggering.
So, the use of health informatics could make the work of compliance much more challenging. We can all expect that there will be more data available and being used, and more complex tools to manage it. This trend exists across almost all industries, and healthcare is not going to be an exception.
In a highly regulated environment like healthcare, however, big data and big data tools will need to be monitored very carefully. There are a lot of ways that data tools could violate regulatory requirements. If compliance professionals aren’t careful, software and other tools could be put in place that expose the organization to high levels of risk.
Staying Up to Date
As of this writing, there is limited information as to what the Office of Burden Reduction and Health Informatics will be doing for the US healthcare system. It has a broad mandate, with unclear specifics.
There is a possibility that the office will make compliance easier, by more effectively assessing the impact of regulations before imposing them. There is also a (stronger) possibility that it may make compliance more challenging, by creating wide-ranging technological systems that compliance officers will need to monitor carefully.
As new regulations are issued, and new announcements are made, we’ll be keeping you updated. youCompli customers always have access to the latest regulatory changes as they come out and will be well-positioned to adapt to the environment created by his new office.
Protecting Hospital Finances in the Post-Pandemic Environment
It’s become a cliche, especially in healthcare, to say that COVID-19 has changed “everything”. One thing that has clearly changed, however, is hospital finances.
Pandemic response stretched every healthcare system in the United States, many to the breaking point. Revenues from non-COVID procedures were significantly reduced, to the point that furloughs of vital medical staff have become necessary.
In this environment, compliance professionals have an important role to play. Ensuring that all payment compliance regulations are being followed helps to protect existing revenue streams, and helps to get the system back on a strong financial footing. As hospitals are getting “back to normal” and trying to find ways to bolster their budgets, good compliance practices are vital.
Outstanding Payments and Patient Insurance
In-hospital treatments declined during the pandemic; however, virtual health visits significantly increased. It’s crucial to continuously monitor payment compliance practices, which include patient insurance information, especially when offering this new treatment vector.
Pre-pandemic, the number of Medicare patients increased by 11 million since 2014, and at least 37 states expanded Medicare eligibility in 2019. While it’s hard to say where Medicare coverage will go as government budgets also come under pressure, these numbers could mean that some outstanding medical bills may be covered.
Historically, about 1% to 5% of self-pay accounts, or patient out of pocket costs, are written off by hospitals as bad debt. Checking and double-checking that your institution has the right information about patients, now and going forward, can be a key step in keeping the hospital financially strong.
The number of uninsured patients has continued to grow — by 12% towards the last months of 2017, and 27 million Americans have lost their employer-provided insurance during the pandemic. Overall, improving payment compliance practices in relation to insurance is an important step in effectively managing these, and other, challenges with patient payment balances.
Reducing Readmission Rates and Penalties
If your hospital serves Medicare and Medicaid patients, you probably know the high number of readmissions that occur in typical months. Readmissions that take place within 30 days of an initial visit cost hospitals a staggering $41.3 billion. In a post-COVID world, these patterns may not hold — but that could mean that readmissions are going to go up, not down.
CMS instituted several programs to try to manage these readmission challenges.
- The Hospital Readmissions Reduction Program (HRRP): rewards hospitals for lowering readmission rates for common health conditions like heart attacks, pneumonia, COPD, and total hip and knee replacement surgery
- The Hospital-Acquired Condition Reduction Program (HACRP): encourages a reduction in avoidable infections resulting from colon surgeries and hysterectomies, bedsores, sepsis, and even blood clots
Hospitals with, according to CMS, higher than average readmission rates face steep penalties and lower claims reimbursement. In the fiscal year 2020, pandemic notwithstanding, 83% of the 3,300 hospitals in the U.S. were projected to face penalties. And these penalties can be as high as a 3% reduction in repayment. Across the United States, CMS penalizes the worst-performing hospitals with a 1% reduction in total claim reimbursement.
As hospitals reopen and restart regular procedures and treatment, and try to rapidly scale revenue generation, more hospitals may face penalties, if compliance practices are not strong. Surprisingly, at least 12% of readmission cases of readmission cases are preventable, according to the Medicare Payment Advisory Commission (MedPAC).
Two ways hospitals can comply with CMS’ regulations and boost patient care are:
- Embrace a process that sends discharge summaries to the primary care physician
- Assign staff follow-up on post-discharge test results.
Setting up such a process can be tricky, especially in larger hospital facilities and in facilities that are still challenged in the aftermath of COVID. Medical staff need to be able to consistently and quickly assign, track, and review summaries and test results.
Monitoring each step of the process is necessary to ensure that your organization is taking the proper steps to adhere to Medicare and Medicaid requirements. That way, your hospital easily avoids significant penalties while boosting patient care. CMS also recommends that hospitals be on the lookout for hospital-related illnesses, which can derail patient care standards.
What You Can Do
Staying on top of the ever-changing world of CMS regulations isn’t easy, especially as we emerge from the pandemic crisis. But we can help by providing you with expert advice and tools that target the regulations and policies needed to run your hospital compliance program more effectively.
Our fully customizable software helps you and your revenue cycle team stay on top of every regulation, so you’ll have the best possible chance of meeting essential mandates, keeping cash flowing and avoiding penalties.
Minimize Regulatory Impact On Patient Care
New regulations are a fact of life in healthcare. But the head of your pharmacy or lab or revenue cycle department just wants to focus on patient care – not reading new regulations.
How would they react if you told them they can comply with ALL new regs without having to read them?
Recently, the Oregon Association of Hospitals & Health Systems (OAHHS) released a report showing that acute care inpatient hospitals must comply with over 2,000 rules created by the state (and that’s JUST the state).
Clinical workers usually bear the most responsibility when states (and others) pass new regulations. Clinical staff must:
- Assess a new regulation’s relevance to the organization,
- Determine what steps need to be taken to comply, and
- Implement the steps required to comply.
This creates big headaches for these folks, as it takes their time away from what they actually want to do: providing care. Meet youCompli. youCompli software monitors, reads and translates regulations into easy-to-understand business requirements. The requirements are delivered to the responsible party and you can keep track of all of it.
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