AHLA's Speaking of Health Law

Virtual Compliance

October 26, 2020 AHLA Podcasts
AHLA's Speaking of Health Law
Virtual Compliance
Show Notes Transcript

Shannon Sumner, Chief Compliance Officer, PYA, and Ritu Cooper, Shareholder, Hall Render  Killian Heath & Lyman PC, discuss best practices for the seven elements of an effective compliance program. They cover how best practices have evolved in the new post-COVID virtual environment. Sponsored by PYA

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Speaker 1:

Support for A H L A comes from p y a For nearly 40 years, p y a has helped clients find value in the complex challenges related to mergers and acquisitions, clinical integrations, regulatory compliance, business valuations, and fair market value assessments, and tax and assurance. P y A is recognized by Modern Healthcare as one of the nation's top 20 healthcare consulting firms, and by inside public accounting as a top 100 accounting firm. Learn more@pyapc.com.

Speaker 2:

Hello everyone. I'm Shannon Sumner. I'm a principal and shareholder with p in our national office , and P is a top 20 healthcare consulting firm and also a top 100 accounting firm . I lead our firm's regulatory compliance service line, and our team specializes in helping our clients with implementations of compliance programs, serving as an independent review organization, the health systems and physician practices that may be under corporate integrity agreements, to also serving as onsite and remote resources to compliance departments and fulfilling their compliance work plans. And then joining me today as we talk about the age of virtual compliance is Reto Cooper . She's an attorney with Hall in their Washington DC office. So, Reto , thank you for being here. And so can you tell our audience a little bit about your practice?

Speaker 3:

Sure. Thanks, Shannon. Um, thanks so much for inviting me to join you today. And I, I know that we really enjoy working together and you figured out a way for us to work together during covid. So <laugh>, so thanks for, thanks for that. I appreciate it. Um, but I'm , I'm really thrilled to, to sit here and talk to you about , um, virtual compliance. Um, as Shannon mentioned, I'm a shareholder with Hall Render Killing Heath and Lyman. I'm in the DC office Hall Render, if you aren't familiar, is the largest healthcare focused firm in the country. I co-chair the firm's compliance service line. Um, my practice primarily focuses around , um, serving healthcare providers such as hospitals, health systems, large physician practice groups, and life sciences companies. When it comes to compliance. Um, I also do a lot of work with fraud and abuse. Uh, so counseling related to , um, compliance with Stark and Kickback assisting compliance with conducting internal investigations that sometimes lead to voluntary disclosures, and then also responding to government investigations. For the last four years, I have served as the interim compliance officer to a few organizations filling , uh, that position as they searched for a permanent solution. I just completed the last interim role a few months ago, so you can't see me. But I am breathing a sigh of relief that being the compliance officer , um, even in an interim role is, is definitely hard. So I feel for all of our compliance officers that are, that are out there. Um, and the last but not least, I do quite a bit of work with providers who are under , uh, corporate integrity agreements, helping them manage those requirements to ensure that they meet , um, all the requirements and don't have any stipulated health .

Speaker 2:

Well, today we're going to discuss the concept of virtual compliance. And , and I know in the age of , um, COVID 19 , working remotely has become a necessity depending upon where you work and what you do. Working remotely can either be a joy to some or a burden to others. And I know personally, I am not a fan of working from home , whereas my husband loves it . I'm not sure how he does it . But however, we all know that our friends in the medical community are challenged in just a variety of ways. And today we're really gonna talk about how the compliance department and the compliance departments can, and in many cases, are overcoming this new, what we're calling a new reality. And as we are thinking about this topic, we thought that covering best practices by each of the seven elements of an effective compliance program. And I know all of us know, and we're gonna have a quiz at the end on what those seven elements are. But let's go ahead and , and start with the first element, which is, you know, program administration. And so, Reto , I know that you've advised numerous health systems on compliance programs from board and , you know , compliance committee oversight to serving , as you mentioned as an interim compliance officer . But from your experience , where do you really see the greatest challenge or even opportunities related to compliance program administration in this era of virtual compliance?

Speaker 3:

So I look at the first element and, and divide it into four prongs. One is the board oversight responsibility for compliance. The second is the role of the compliance officer to lead that compliance effort at the organization. The third is the compliance committee's, support of the compliance department, and specifically the, the roles and responsibilities of the compliance officer. And last but not least, the visibility of the compliance , um, uh, culture throughout the organization and, and really visibility of compliance department. So if we look at the, the board oversight, I don't really think much has changed, right? The board is not supposed to be hands-on. The board is not supposed to be involved with day-to-day , uh, compliance activity. They, they rely on that delegation to the compliance officer, and then therefore the compliance officer's department and the compliance committee. So, not having the board come on site , I don't think is a, is a huge deal when we're talking about virtual compliance. Now, what we might see, or, or we might have affected is the board's interaction with the compliance officer, right? So not every compliance officer is in front of their board at every single compliance meeting. They might only have that one opportunity a year where they give compliance education, maybe they give a compliance report, and usually they're talking to maybe a smaller subset of the compliance , uh, I mean, of the board in that compliance committee or auditing compliance committee, depending on what, what they call it. Um , so I don't think that the, the board oversight really changes. You may wanna do video calls instead of audio calls to have a little bit of FaceTime with the board. Um, but I don't see that much opportunity. When I think about the, the board oversight, if we don't look at the compliance officer's role, again, I don't think much has changed in the fact that the compliance officer is responsible for setting the stage and the tone for compliance throughout the organization. Now, what has changed is the amount of information the compliance officer and their department needs to take in, right? I mean, we know that since March , um, and probably within the first 60 days, there were so many regulations and waivers and temporary orders that came through from the government designed to help organizations kind of survive , um, in this pandemic state. But that meant that now the compliance department needed to be an overdrive of paying attention to all of those , uh, different changes and waivers that are coming through. So in that sense, luckily everything's available online, right? So , um, you know, maybe having your, your soldiers helping you , um, within your compliance department, and then also delegating to the compliance committee. Um, so then that leads kind of to the compliance committee. We all know that engaging the compliance committee has always been challenging. Um, partly because we wanna look at a cross-section of the organization to be on that compliance committee so that they can help the compliance officer in the department with their compliance responsibilities and, and be really their liaisons all over the organization to help them be aware of what's going on. Well, engaging them usually requires that face-to-face, right? That real touch , um, calling on someone that's in the meeting or asking someone a , a question and having that dialogue. So we need to be a little bit more creative. You know, perhaps we need to make sure that all of the meetings are by video, so at least there is some sense of dialogue. Um, maybe it also means meeting , um, more frequently as opposed to less frequently, especially in light with all of those changes that have been coming out from the government , um, delegating responsibilities of maybe various departments being responsible for certain changes. So for example, maybe laboratory is responsible for anything that comes from the government related to lab , um, and then charging those individuals with sharing that information at the compliance committee. And I think that is a way to make sure that they're engaged and they're also providing information that's helpful , uh, to the group. But the most challenging, I think, in this world of, of covid and virtual compliance is the visibility of the compliance program. Um , pre pandemic, the compliance officer or people within the compliance department could roam the hallways. They could eat in the cafeteria, they could pop into a meeting, they could visit the department. Um, they could have, you know, as, as we were preparing for this, Shannon, we talked about those hallway conversations. Um, they could sit in on a morning huddle, they could do a walkthrough to a physician clinic and maybe see something that might be amiss and then assist with, with some compliance or, or ask questions. Um, but obviously with some people working from home, whether it is people within the compliance department or those that are, are the front lines that are, that are providing services, we now need to think of a different way and a , a creative way of ensuring that compliance is in the forefront of everyone's minds, right? We don't want this out of sight, out of mind mentality. So maybe what the C C O does the, the compliance officer does, is , um, take a look at that calendar and see which meetings they could pop into, right, via Zoom. If, if there are , are Zoom meetings , um, maybe the compliance officer now, now starts hosting office hours, like whether it's a , uh, breakfast with the compliance officer or the compliance department, or maybe a lunch and learn, or maybe a happy hour. But something to allow people to have access to the compliance officer, because as we know, access to the compliance officer is the most important thing. Um, when you want people to come forward and for them to remember that compliance exists. I mean, obviously our clients are out there trying to do the right thing every day , um, but they're not always thinking about, well, let me run to the compliance officer, ask a question. But when you see the person here , they , they feel accessible. It's much easier to , um, to have that dialogue and have the questions. Another idea could be most everyone is working , who's working from home, has their laptop, right? So they have their work laptops, and maybe you , uh, have the compliance department sponsor a screensaver every month, and that screensaver provides something. Maybe it is a reminder of the hotline, maybe it is information about covid and some new waiver that has come out. Or maybe it's talking about some of the relaxations and now have lapsed, and now we're back to normal, whatever normal, normal might be. Um, so I think really inviting people to come and engage with the compliance officer to make sure that they remember that compliance exists , um, and of their roles and responsibilities, I think would be really important. So Shannon, that then leads me to wanna ask you a question about element number two, looking at policies and and procedures. Um, can you tell me what you've seen providers do or what recommendations you have for providers in this virtual role of this virtual world? Um, as, as we look at policies and procedures,

Speaker 2:

Well, we know that this element of policies and procedures is the most exciting element of a, of a compliance program. And I can say that from being , um, a , a former internal auditor, and I guess I'm still an internal auditor at heart, but, you know, as we, we talk about policies and procedures and , you know , as organizations are really having to shift from how they conduct their daily activities, I mean, their daily activities have have changed because there will be certain activities that switch from being face-to-face or manual processes to now there's gotta be an online or remote. If we're gonna continue to, to do business, we have to learn how to embrace technology. Um, even though it was very, very late in the game when I, when I actually embraced , um, uh, going away from paper calendars, so I can understand some of the, the struggle that that's , that's out there. But I would say as these , um, activities shift, the underlying procedures really need to be updated. And so, for example, organizations may have never considered electronic signatures on contracts before. And, you know, as we know the contract and, and the terms, for example, with physician relationships, I mean, that has to continue to go, but all those types of reviews require the same level of, of scrutiny and review. And you really can't bi bypass some of those core control elements just because we have to do it online. And, you know, with that being said, with electronic signatures , um, I think we're, we're gonna have to, to understand, you know, who, who can be allowed to use electronic signatures, for example, are they approved up to a certain amount? And I know, for example, our firm had to quickly pivot to allow electronic signatures in certain cases , um, from multiple organizations that we worked with. Um, there has been either an embracing of, of file systems like Dropbox or share file. And if so, you know, how are these , um, how is this information being protected? You might have a situation where you're putting more , uh, PHI in into those share file systems and, and Dropbox, and you really have to work with your technology department to understand, are we putting the organization at risk? So when you think about your HIPAA policies and procedures, certainly, you know, security , um, physical access, those things have to be reviewed to make sure, because we just don't know how long this thing's gonna last. And we also don't know, you know, maybe this is a , a good way for us to really start embracing new ways of, of, of serving our patients and new ways of serving our, our coworkers in , in terms of using some of this electronic , um, media for, to , to help us work remote. And then also too , um, and when you think about your, your workforce in a health system, you certainly have the, the bedside that the patient caregivers. I mean, that, that is something that they have to continue to do, and that's not an option for them. But for those that might be in the, in the health information management department , um, working on, you know, electronic health records, they may have to be doing some of this remotely. And do they have the knowledge, you know, do they have the, the laptops that are available for them to, to work at home? Are there certain minimum firewall standards when you have a work at home situation? I know that's something that, you know, we as a firm wanna wanna make sure that we're protecting all of our confidential and patient information when we're working with health systems to tax returns. And so that's something that we're having to make sure that all of that, the , the mechanisms that we employ, that we have the right policies and procedures to do that. And you know, also too, when you're working at home, and if you're, you're working in an environment where you're, you're dealing a lot with that protected health information, you might be , uh, scanning a , a medical record just because it's easier to, to look at and, and to code rather than doing it online. Then what do you do with that information? Do you have the proper mechanisms in place to be able to dispose of that confidentially? If, if you've got someone within your workforce that is, would rather shred at the office or shred at the hospital, we've got the transportation of that , um, um, information from, from their remote work area to actually being at the hospital. So those are things that , that have to be evaluated. Um, and, and certainly an another area that will definitely impact the future training. So if you have some of these processes that aren't gonna change, you're gonna have to make sure that you've got good training related to any changes that that come about because of our, our new virtual compliance reality. And, you know, speaking, speaking of training re two , I wanted to get your thoughts on maybe some challenges or best practices that, that you have seen with working with within your role within these clients.

Speaker 3:

Um, so yeah , so Shannon , I think you're right with training. I mean, once you've developed those new policies and procedures, whether they are permanent policy and procedures or stand in right, for a short period of time, so temporary policy and procedures, you have to then make sure that you disseminate that information to the masses. Um, so I think the two biggest challenges with the training education virtually , um, one is related to physician training in the past, and , and I , I think past experience shows this, that live training is probably the best way to actually engage with your physicians, right? If you give online training online modules to physicians, they might click through it, but I don't think you get the same level of, of engagement and dialogue that you do when you sit down with them for an hour. You know, whether it's through grand rounds or a , a meeting or a dinner or something where, where you talk to 'em about the issues and things that you want them to be aware of. Um, but that option is just might not be there right now. Um, so we need to, to think about how do we make sure that we provide meaningful training to physicians and have them engaged . So maybe, you know, we're wrong and maybe the online modules didn't work before, but maybe pilot a new way to provide the training to physicians. Um, you know, maybe the online module for them looks a little different than the module that you have , uh, for, for the other employees throughout the organization. Or maybe you try , try to make it as live as possible and set up zoom meetings. And maybe this will be a little more taxing for the compliance department, but maybe you set up Zoom meetings with smaller groups of people, right? I think that we've all been on these Zoom calls , um, and I've been on Zoom calls with two people, and I've been on Zoom calls with 500. Well, with 500 you're not gonna see people's faces. Um, you barely even see everyone's name unless you click the , the participant's tab and then you see everyone's name. Um, so maybe thinking about that, you know, maybe having physicians sign up for , uh, for a smaller group session , um, throughout, you know, throughout the rest of the year. Um, and obviously we know that not providing training is not an option, right? So we, we need to make sure that everyone is trained annually, including the physicians. And so this virtual training with them might be a little bit challenging, but maybe we figure out a way to survey what the physicians want and we provide, or maybe we provide different mediums depending on what the physician wants. Maybe they can select an online module or, or a Zoom call, but they just need to complete it . But you hit it on, on the head , Shannon , when you were talking about, okay, we changed these policies, now we to train on them . So the biggest challenge, I think is gonna be creating and disseminating new training materials on new policy and procedures. Maybe the new waivers, maybe some new regs that have come out in short order. But we all know that it, you don't just snap your finger and your fingers and , and the training module is created. It takes a lot of careful work because you wanna make sure that it's properly received and that you know, it , it fits your timeframe of whether it's a 30 minute training or a one hour training, and you're giving just the right amount of information on this module and, and people can digest it. Well, now we don't have that time to be that careful because things are changing rapidly. And we need to make sure that everyone in the organization is getting real time guidance on how they can comply with the new rules and regulations and the new policies and procedures that have been put forward. Like, you gave a great example about work from home and what the expectation is with paper. Do we expect everyone to shred at home because we don't want the added risk of them driving back to the office? Um, if they shredded home, do we provide the shredder to them? That's another expense for the organization. I mean, so there's so much that we need to think about and we need to make sure we have clear and concise training. So perhaps with all these new changes, you can't now roll out 30 hours of new training. You might n need to be very direct into the point related to it, but we need to make sure that folks understand , um, the new expectations that they might have. Um, so with that, that means that the compliance department needs to understand what waivers and what changes the organization has taken on in order to know what those positive procedures are that you've talked about that they need to address. And then what training needs to be, needs to be put into place. And the whole purpose behind training is to make sure that we reduce the amount of frustration amongst the workforce. We do not want the workforce to be frustrated of not knowing how to act and what to do going forward. We also don't want the , uh, workforce to be confused that they think that now there might be someone who is doing something that's inappropriate, when in fact it's perfectly appropriate for them to do what they're doing because of the waivers that exist. So the training, I think, has to be kind of staged, right? There might need to be some training out there on, hey, here are the new waivers that have come out. We're thinking about , uh, taking advantage of them, and then maybe we're taking advantage of them , and now we've rolled out new policy and procedures. So transparency I think is super important, especially , um, you know, as we move into element number four, Shannon, and talking about open lines of communication. Um, so, you know, is virtual compliance having an impact on, on the open doors policy from, from your perspective and what you've been talking to clients about?

Speaker 2:

So, you know, in my opinion, I think time will tell. I think time will tell if working remotely or virtually will have an impact on this element. So just recently , um, we actually helped an organization, we did a compliance program , compliance program assessment. And usually when we do these, we're obviously gonna be doing these in person . And one question that we typically ask is whether an indi an individual has ever witnessed or has been personally affected by retaliation. And so when you're in a group setting and you're asking , um, individuals this question, one of the telltale signs is that you might be onto something as someone looks at someone else. I mean, you know, you and I have been been part of, of some, some interviews before together. We know that just the , the power of being in person , having a dialogue, having a relationship, you know, when you're face to face , I feel like there's greater , um, confidence in your ability to, to share with one another. I mean, even, even in a , you know, a client situation that we might have just met someone for the first time, I still feel like just being in person creates that human element of, of connectedness. And so I feel like that could be a challenge, particularly as it relates to, you know, investigations and, and thinking through do people feel comfortable about communicating what they see are potential issues and how do they, how's the best way for them to go about it? Um, you know, I would think another element that you mentioned is, is I feel like these types of matters come to light more easily when you are visible, when the compliance officer is visible, there's those hallway conversations to, you know, someone will say, you know, I saw something the other day and I just wanted to get your thoughts about it. Or, you know, can you help me understand a new policy and procedure? Or, you know , just kind of walking by and, and you know, popping into your office, not just from communication with the compliance officer, but communication within your teams. You know, certainly , um, health systems want to encourage that open door policy. They want employees to feel empowered and feel comfortable and feel confident in like, having that conversation with their supervisors. You know, certainly when you call a , you know, a , a a hotline, it is something that, that is a requirement to have that, that ability to be anonymous. But sometimes you just kind of wanna have that dialogue cuz Reto , as you mentioned, and I really hadn't thought of that before, but the education piece is so critical when you've got these waivers, cuz you're right, there could be something that that is so unheard of, you know, in , in , in , in the compliance world and in terms of particularly like physician contracting and licensing, the things that we thought, well, that would never happen. And now these things are happening because it it , it enables us to serve our patients. And without having that, that level of education and training or having that open door policy to be able to go and have this dialogue, I think it's gonna be a challenge now, you know, but I, I think on the flip side, and , and we were talking about this earlier, I think people may also become more frustrated in trying to do more with less in the era of covid . You know, they're , they may have fewer resources, they're, they're overworked and they still have to have the means to be able to report concerns. So there could be an increase , um, in the types of, of a number of hotline calls that come up or reported directly to supervisors or compliance officers. So I think it really is an opportunity for compliance to reiterate the importance of speaking up , um, when you are overtaxed either, you know, fiscal resources , um, or associates resources, not having the right , um, ability to execute how you normally would want to, and in a quality way. There's, there could be potentially some bypasses and some shortcuts and processes, and certainly that is a risk to the organization, whether it's a quality risk, compliance risk, financial risk, reputational risk , um, just being able to have that mechanism to do so. So that's one thing that I would encourage , um, you know, for our listeners who are compliance officers is to, to, to really think about the categories of when you've trended your hotline. You know, it might be , um, time to look and see now trend it before Covid , um, happened , trending it now to see what, what led to that? Is it because, because we were doing more of the, you know, virtual type of town halls, where were we increasing visibility because we kind of got com may have gotten complacent and just going to a meeting once a year and, and , and having, you know, just that hotline availability, but really being proactive about being visible could then in turn increase the , um, the, the rate at which associates feel empowered to communicate. And they, they have that mechanism to do so. So this will be interesting to see. Um, I'm, I'm really would be interested in any of our clients that are, that are doing this and certainly would advise them to, to kind of trend the types of, of hotline calls , um, with before and then after covid. So, you know, next the , you know , as it goes into the , the next element, and of course this to me is the most exciting other than policies and procedures, is the, the auditing and and monitoring aspect. So, Reto , I know you and I have been involved in conducting risk assessments together and, and helping our clients develop those, really, those robust work plans. But where do you see the risks or opportunities in executing a compliance work plan in this virtual age?

Speaker 3:

So I think the first order of business , um, is to evaluate the work plan and determine which items on the work plan, whether they're audits or or monitoring activity was something that was being planned to be conducted in person , right? So we know that that's a bust <laugh> , that's, that's not gonna happen. Um, and so we can't, we can't say that, okay, well let's just take all those items off the work plan, right? We, we need to reevaluate those items and see how can some of that auditing and monitoring that we had planned to do in person , uh, be conducted remotely. And if, if it can be connected remotely, then then great. And if it can't be conducted remotely, then maybe , maybe thinking of a , a safe way to be able to, to get the information and extract the information that needs to be extracted. Um, you know , I don't, I don't think the , the government's gonna be that receptive to a provider just saying, okay, you know, virtual compliance, we're just gonna suspend all of our work plan activity because we're work from home and no one's really in the office because work is being done. Um, now I don't think that means that we can visit people's homes, right? I mean, sometimes we, we go and visit someone's office and, and we might talk to them, we might ask to see documents or something when we're conducting a risk assessment or an audit or whatever. I , I just think the, the , even though it's work from home, I think home is, is a safe place, right? So that is not, that's not an opportunity, I mean a solution for this, for conducting audits and , um, and monitoring. So I think we just need to think creatively and figure out how we can accomplish the same tasks remotely. The other thing is the actual substantive items in the work plan itself. Um, since the pandemic, there have been over 40 items that the OIG has added to the OIG work plan related just to covid. Um, and , uh, and this is October. I mean, there'll , there'll probably be more, I mean, every , every month since June, there have been a few that have been, have been added. So, you know, this Shannon, I mean, years ago we used to think that the OIG work plan was annual, and every October around this time, we'd get on the website for the O I D , um, and see what new work plan had come out and what items were shedded, you know, shed from the, the year before, what new items were on there. We'll , you know, few years back, the government obviously has changed that and, and moved to more of a monthly. So with that, that's also required our clients also to make their work plan more dynamic. I think pre but before that, we didn't really have a dynamic work plan, right? We had a work plan, we set the items on there, and we tried to accomplish them within the 24 months. Yes, there might have been new things that came up, but we didn't really think of them as additions to our work plan. There were just new items that came up because of a follow up from an investigation or a follow up from a hotline call or an inquiry that came in. But now we're very proactive with looking at the work plan and , um, revising it. Now, we also know that a work plan of a hundred items is not necessarily something that is, that can be accomplished. So if we have 40 new items that have come on to the OIGs work plan that are covid specific, not all 40 are gonna be relevant for our organization, right? So we're gonna need to have to co conduct some kind of risk assessment or stress test to see which items are relevant. That probably means that the compliance department needs to be talking to the business to figure out what advantages we've taken. I mean, what , uh, waivers we've taken advantage of , um, what relaxations there are that that, that we can say that, that the organization is looking at. And then also, you know, have we taken any money? I mean, there might be new terms and conditions that we have agreed to that we now need to make sure that we are, are monitoring to ensure that, that we don't , uh, we don't fall into, into a , a period of non-compliance. So that being said, I think that if we can think about the work plan and it being dynamic and making sure that what we have on that work plan is, is achievable , um, I think of this virtual world, we'll be able to meet that, that element. Now, the other thing that I think that we also need to think about is if we're going to take some items off of this work plan and put something else on, I do think we probably need to document the rationale behind it. Because if we put on the work plan to begin with, and we're taking chunks off, it's different when you take one item off here and there, but when there are 40 new covid specific items, and let's even say only a 10th or 20% of them or things that apply to you and you decide to put them on, that's four to eight new items you're putting onto your, to your work plan, that means four to eight items might come off. So we would wanna probably document , uh, the rationale behind it or maybe just say, we're suspending it for now taking care of covid stuff, and then we'll make sure that those are not forgotten and we add them to the 2021 work plan or , or something, something like that. So , um, I think that, that the auditing and monitoring is something that we just need to make sure that we don't lose sight of, and we figure out ways to, to ensure that we're connecting with people and, and we're collaborating with the different audits , um, that need, need to be done. And some of it might even mean outsourcing, right? I mean, I, I know that a number of organizations have cut back on their expenses and budgets and, and obviously the first thing to go would be outside help. But, you know, if there are enough things that the organization needs to focus on, then then auditing and monitoring might be something that they could reach out to maybe p y a or or another organization to help with, with some of those items to make sure that they don't lose sight of the things that, that they need, they need to have covered. Um, but being that most people are working from home, Shannon , um, I'm, I'm thinking about discipline and monitoring discipline. How are employees able to monitor and ensure that discipline is fair and consistent across the organization when you might have only had one location or a couple of locations, but now you have thousands of locations because people are

Speaker 2:

Working, working from home. Mm-hmm . <affirmative> , you know , I think again, that's another area that is going to be a challenge. And as you mentioned, you know, either, either they're working at home or the, the supervisors are working at home. But, you know, I think in this day and age, you know, I know, I know we've been talking a lot about remote the remote workforce, but I feel like, you know, even before Covid over the last few years, there's probably been a lot more migration to that and the organizations have, have, have really thought through in terms of how to monitor performance. I think performance is gonna be a lot easier to measure than, than, you know, behavioral issues. Now, it could be an upside, you know, if you're not working with Sally Joe that you don't like to get along with very much, and she's not working with saja , then from a remote , remote standpoint, you might actually have a better outcome from, from that perspective. But one area that , um, we were talking about earlier , um, in preparation for this is also related to , um, you know, keeping an eye on, on those excluded providers. And I think a , a great example, Elise , one of the ones that that first came to mind for me when some of the, the covid waivers came out was actually licensing. And, you know, I know some of the waivers for licensing really on are on that state by state basis. Um, flexibilities were granted to allow those healthcare professionals who are licensed in one state to practice in another state and in , you know, even though a , as part of that emergency , the emergency declaration, but for many organizations, you know, the exclusion checks, you really have to make sure that you're still doing that. That is not a waiver. Um, and exclusion checks , um, you know, in our experience, a lot of times that's done at point of licensing it , it's done, it's part of the credentialing process. So I think that's another example of how one process change on a temporary basis could have downstream effects on another process. And so I know we, we've kind of lumped in dis , you know, disciplinary actions with excluded providers, but they, they really can go hand in hand depending upon what gave rise to the excluded provider being on, on that particular list. But, you know, as, as we go through this, I think, again, this is just one example of how some of these temporary processes can really have that downstream effect and, and the compliance officers should really review all of those covid wa waivers and analyze for, you know, possible gaps and other requirements. But back to your original question on the disciplinary action, you know, there , there should authority been a particular policy and procedure related to the types of, of issues that give rise to different levels of disciplinary action. And it is gonna be imperative that there is greater scrutiny related to, not only from a performance aspect, but from a , a culture of, of compliance. And , and I love the fact that when we started out this conversation, you're really talking about being visible, maintaining that culture of compliance. And, and I know for, for, even within our, within our firm, I think we've embraced more of the, the video dialogue and calls with groups of individuals. You know, we have associates in, in, you know, multiple states and historically we just kind of relied on, on telephones to, to have that conversation. Now with video, I feel like we're even more connected and it's helping us to maintain our culture, keeping everyone, you know , informed of what's going on. I think that's gonna be critical. Um, as organizations continue to move through that. Um, I think senior leadership need to have, you know, one, one thing that we've seen done quite, quite well is, is senior leaders, the C-suite will have podcasts like this. They'll also have video town halls to keep people connected. Because all the things that we've talked about today related to , um, the elements, I think it's gonna be really, really important to maintain that culture of compliance. And so, you know, I know , uh, retu , one of the , our last areas related to investigations. I know we discussed not being able to read that body language during a virtual investigation, but what are some of the potential gaps that you feel could exist in that, in that investigations process?

Speaker 3:

Right. I mean, you're right. The first, I mean, probably the most, most important one or the , the , the most glaring one is, is not being able to read people right? And seeing them face-to-face. Uh , to me there's two others. I think one is documentation , um, and how important it will be to make sure that you document every aspect of your investigation. Because when we were in person , there might have been a team of people in the compliance department and maybe even with the legal department or outside counsel , helping with an investigation. And so you could have other people hold you accountable to what you're doing. Now a lot of people are working completely on their own. I mean, I think compliance departments are, are trying very hard to have huddles , uh, weekly and have the team together on a zoom meeting like you mentioned. But your everyday work is not, let me walk into my office and let's review this document that came, or let's review this email together. It , it's mainly people reviewing separately and then maybe talking afterwards. But I do think , um, that that patient aspect is going to be really, really important to make sure that the investigation , um, doesn't have any misses throughout the process. Uh , and, and with the virtual world, you know, the 68 rule is not going anywhere, right? So I mean, we still need to comply with the 60 day rule of after you've quantified and , and identified , um, an overpayment. And so I think we need to make sure that, that we document what we're doing and how we're doing it. Um, the other one is momentum. You know, I was working on , uh, an investigation with a client pre covid and you know, we were rolling and I came on site and we did interviews and uh, we had plans for next step and then Covid hit, and then it was just radio silence. Now I'm not faulting the client, and I'm not even faulting myself, quite frankly, because things change . I mean, one thing that we haven't talked about, which is a reality for many people is there are a number of people that as they're working from home, they've also become teachers. Mm-hmm. <affirmative> not certified. Um , but they've become teachers because they're homeschooling their children. And so it's is something that is going to be challenging to make sure that we don't lose momentum on those investigations. And we, we need to make sure those investigations are moving quickly so that we can identify in a timely manner and then hit the 60 day rule, you know , uh, the 60 day mark once we've identified it. So I think we need to make sure that, that we are cognizant of the teams that are working on different matters and being realistic of what the expectations are and how we are progressing through the investigation. Um, you know, another colleague of mine and I did an investigation of , of an organization that , um, thought and, and actually did have some research misconduct and interviewed the person who was leading that charge. Um, and thank goodness we did it by video because I could read the body language right away, right? So , um, the Zoom call totally helped in that situation. I don't think I would've been able to get the same message from her had I just been listening to her respond. Um , because, you know, there, there could have been a lag in, in the response because of connectivity or something as opposed to me really feeling the angst that this individual had during, during the investigation. So, so I think that, you know, you know, the, there are a couple of themes that we've pulled out throughout this discussion about virtual compliance. Um, one is to make sure that there's visibility of the compliance program. The second is to make sure we're being creative and with creativity, that we are being flexible and, and really making sure that we are constantly looking at this compliance program and figuring out what, what can be done to make sure that we're satisfying our requirements and what can be done in the most efficient, efficient way. An investigations is one of those ones that, because it , they could lead to a voluntary disclosure or an overpayment or something. We need to make sure that we are fluid , um, with that, with that element and , and kind of the solution in the virtual world.

Speaker 2:

Um, so we hope that, that this is given , given you all food , food for thought . And even though it's , it's the virtual age that we're, we're thinking through. Um, you know, I think one key point here is , is sometimes that this chaos will bring us new opportunities and as chaotic as things are due to the pandemic and that, that is for nearly every organization out there , um, now is not the time to put compliance in the backseat . And I think, I think we all would appreciate that. It's to be creative, as you mentioned, and kind of roll with the flow. Um, but virtual compliance may be here to stay for a while, so let's get comfortable with some of these new solutions to meeting, to meeting our compliance obligations. And so I think we've, we both have learned from, from one another , um, during this, during this planning and, and having this podcast. I think it's been fun. It's , it's certainly an area that , that I hadn't really had to think about, you know, before, when did this all start to January, February, March, April, sometime in 2020. Still, still in 2020 . Um, but I think hopefully our, our listeners will, will have gotten some tidbits outta this. And, and certainly feel free to, for contact either one of us for, for, for a better dialogue. But we appreciate it. Um , we appreciate our listeners and we too appreciate you joining me for likewise, Shannon, our virtual compliance talk.

Speaker 3:

Likewise, thank you so much for, for inviting me to, to chat with you about thinking about virtual compliance since , like you said, it might be here to stay for a , for a minute.

Speaker 2:

Absolutely. Well, thank you very much everyone . Have a great day .