Pointers And Pitfalls In Gaining Physician Buy-In To A Compliance Program

1. Pointers And Pitfalls In Gaining Physician Buy-In To A Compliance Program Robert H. Ossoff, D.M.D, M.D. Assistant Vice Chancellor for Compliance and Corporate Integrity Vanderbilt University Medical Center Nashville, TN 2009 THA Fall Compliance Conference October 21, 2009

2. Pointers And Pitfalls In Gaining Physician Buy-In To A Compliance Program • Interacting with physicians • Building physician - compliance office relationships • Utilizing and leveraging relationships developed with physician champions Objectives

3. Interacting With Physicians • Know your audience • Know their focus • Know their compliance risk • Know their characteristics

4. Interacting With Physicians • Know your audience • What is their main focus? • Patient Care and patient safety • What is their compliance risk? • Documentation problems • Billing for services • Not Documented • Poorly Documented • Up-coding and/or down-coding • Risk management issues • Incorrect reimbursement issues • Increased cost to correct mistakes

5. Interacting With Physicians • General characteristics • Usually competitive in nature • Like to be the best or a leader in their field • Compete with their peers as well as themselves • High school to college • College to medical school • Medical school to residency and fellowship • Residency and fellowship to private or academic practice • Like challenges • Desire perfection • Want to be correct

6. Interacting With Physicians • General characteristics • Interested in processes that • Improve quality of patient care • Improve productivity • Improve patient satisfaction • Improve efficiency • Improve reimbursement and cut cost

7. Interacting With Physicians • General characteristics • Education • Highly educated in their field and/or specialty • Usually interested in advancing their understanding of the healthcare industry • Specifically interested in understanding outside factors that may impact them • Personality • All walks of life but share common traits such as: • Want to do the right thing • Analytical thinkers • Usually collaborative • Research, science and fact based oriented • Entrepreneurial

8. Interacting With Physicians • Capitalize on their general characteristics • Competitive by nature • Provide data when discussing compliance concerns that compare them to their peers, locally, regionally, and nationally, if possible • Be mindful of their time • Just the facts Pointers – Building Bridges

9. Interacting With Physicians • Capitalize on their general characteristics • Appeal to their interests • Demonstrate how documentation can • Improve the quality of care and decrease safety risks • Improve overall productivity and efficiency • Improve patient satisfaction • Improve reimbursement and cut cost Pointers – Building Bridges

10. Interacting With Physicians • Capitalize on their general characteristics • Education • Provide examples relative to their specialty • Provide data from their specialty organization • Explain how this helps them to be in the top of their profession and how compliance impacts their specialty • Personality • Ask for their input on how to better improve compliance • Provide facts about what needs to be improved and why • Explain why this is the right thing to do Pointers – Building Bridges

11. Interacting With Physicians • Conversation starters • Dr. X, the Compliance Office has identified an opportunity you can use to • Improve patient care and patient satisfaction • Reduce risk to patient safety • Ensure your documentation can be utilized more efficiently by yourself and other practitioners • Ensure your documentation reflects the excellent care you provide to your patients Pointers-Building Bridges

12. Interacting With Physicians • Generally, don’t start off conversations with • In accordance with the law you must .... • The OIG said…. • CMS Billing Manual citation…. • Penalties under the False Claim Act are…. Pitfalls – Instant Bridge Burners

13. Interacting With Physicians • While these are great ways for Compliance Professionals to discuss compliance issues, physicians may be thinking • Here we go again, non physicians telling me how to practice medicine • This person doesn’t care about the patient • Great, more work for me to do because some clipboard-carrying administrator or blue-suit behind a desk feels my job isn’t difficult enough already • Who are you in Compliance to tell me how to run my practice Pitfalls – Instant Bridge Burners

14. Interacting With Physicians • Appeal to their interests to improve patient care • Appeal to their competitive nature • Understand how to phrase and tailor your discussions and educational efforts with physicians so that each encounter is as effective and efficient as possible • Remember, the goal of most physicians is “the patient comes first” so try to work compliance into their daily patient care routine • Above all, most physicians want to do the right thing!!!! Summary

15. Building Physician - Compliance Office Relationships • Politics • Developing physician champions • Who, what, where, when, why and how • Theory to implementation • Vanderbilt approach

16. Building Physician - Compliance Office Relationships • Politics do play a role • You need buy-in from the top • CEO, CFO, COO • These individuals have a significant, vested interest in compliance. It is these individuals with whom you discuss increased efficiency, decreased risk of penalties, fines, and so forth • If these individuals are on board with the compliance program, it should make it easier to get physician buy-in and involvement • These individuals may be able to help encourage physician interaction with the Compliance Office

17. Building Physician - Compliance Office Relationships • Develop your Physician Champions • Where to start? • Respected physicians you know may be sympathetic to the goals and objectives of the Compliance Office • Grass roots approach • Which physicians are already involved in compliance-related areas • Risk management • Quality measures • Patient safety • CMO and COS • Accreditation and Joint Commission • Physicians with prior experience of an OIG investigation or a CIA • Other

18. Building Physician - Compliance Office Relationships • What will the Physician Champions do once the relationship is developed? • They are eyes and ears among their physician colleagues • Report on areas of concern from a physician’s point of view • They serve as advocates for the Compliance Office • They may be the ones to carry the “compliance torch” among their peers • Most importantly, they are your liaison between the medical staff and the Compliance Office and can be instrumental in advocating for change within an organization • Assist with breaking down the us vs. them mentality • Encourage reporting of violations and suspected violations • Influence physician participation in educational programs

19. Building Physician - Compliance Office Relationships • Theory to implementation - Vanderbilt approach • Several years ago implemented a program involving physicians to advocate for compliance • Designated Coding Experts (DCE) and Designated Coding Advocates (DCA) • Compliance liaisons for faculty physicians and Compliance Office • Meet monthly to discuss changes related to coding, compliance, proposed regulatory changes and changes to the healthcare industry in general • Representatives from all specialties are involved • Supported by leadership (CEO, COO, CFO)

20. Building Physician - Compliance Office Relationships • Politics • Get buy-in from the top • Learn the landscape and develop your Physician Champions • Implement a program with your Physician Champions that works for your organization • Remember these Physician Champions are your greatest advocates to facilitate delivery of your compliance message to the medical staff throughout your organization Pointers

21. Building Physician - Compliance Office Relationships • Politics • Buy-in can not come by compromising on ethics or integrity • Result in less than favorable participation from your Physician Champions • Devalue your program and set you up for failure • Failure to know your audience is a disaster waiting to happen • Not all models work for every organization • Monitor the compliance message your Physician Champions are communicating to the medical staff Pitfalls

22. Building Physician - Compliance Office Relationships • Buy-in is critical • Have to understand your corporate culture to select and develop your Physician Champions • Build something that works for your organization • Be sure to communicate and monitor the compliance message being delivered by your Physician Champions Summary

23. Utilizing And Leveraging Relationships With Your Physician Champions • How can the Compliance Office help the Physician Champions? • Think macro and micro • DCE and DCA - Vanderbilt’s approach • Make it work for your Physician Champions and you • Think win-win

24. Utilizing And Leveraging Relationships With Your Physician Champions • How can the Compliance Office help the Physician Champions? • These Physician Champions will receive questions from their peers so it is critical that they understand some basic high level compliance issues • Macro level – be their advisor • Physician Champions will need assistance from the Compliance Office

25. Utilizing And Leveraging Relationships With Your Physician Champions • How can the Compliance Office help the Physician Champions? • Physician champions will need assistance from the Compliance Office • Understand the Compliance Program Plan • Why we have one in place and how it impacts the daily lives of their physician colleagues • Conflict of interest • Fraud and abuse laws (Anti-kickback, False Claims, and Stark)

26. Utilizing And Leveraging Relationships With Your Physician Champions • How can the Compliance Office help the Physician Champions? • Physician Champions will need assistance from the Compliance Office • Major changes within CMS (FI and Carrier change to MAC, PSC to ZPIC, RACs and MICs) • Understanding the acronyms, alone, may be overwhelming!!! • Major proposals such as the elimination consultation codes and how this will impact their organization and practice

27. Utilizing And Leveraging Relationships With Your Physician Champions • How can the Compliance Office help the Physician Champions? • Macro level – be their advisor • Assist with annual compliance training • Helps with both clinical and non-clinical staff to see that the Compliance Office is utilizing physicians to assist and provide guidance with training

28. Utilizing And Leveraging Relationships With Your Physician Champions • Micro level – be their consultant • Individual physician audits • Utilize your Physician Champions to help explain audit findings • Less intimidating for the audited physician • Helps transform the audit into a collaborative approach to address the findings, mitigate the risks, and improve patient care • Specialty compliance training • Training is provided by someone in the specialty practice • Peer to peer training • Provide real-world insightful examples and commentary on why compliance is necessary within the specialty

29. Utilizing And Leveraging Relationships With Your Physician Champions • Micro level – be their consultant • Billing, coding, documentation and operational issues • The Physician Champions encounter the same issues all physician’s encounter so they can provide assistance with resolving these issues as they arise • Leverage their “referral” behavior and training • The Physician Champions can “refer” their peers to the Compliance Office to assist with questions or concerns

30. Utilizing And Leveraging Relationships With Your Physician Champions • DCE/ DCA – how the Physician Champions help the Compliance Office • There are many benefits for the Compliance Office to utilize this approach • Impact to the organization’s culture • Physicians participate with the Compliance Program so they too want to see it succeed • It’s our program, not just the Compliance Office’s program • Compliance is seen as part of the job – part of the daily routine • Are we perfect? No, but non-compliance is seen as imperfection and culturally we strive for perfection

31. Utilizing And Leveraging Relationships With Your Physician Champions • DCE/ DCA – How the Physician Champions help the Compliance Office • There are many benefits for the Compliance Office to utilize this approach • Education • Changes to CMS requirements that involve changes to physician documentation is far more easier to implement • Education, is easier because the Compliance Office has excellent access to various committees through the Physician Champions • Network • You are automatically “linked-in” with the Physician Champions’ peers • Creates the perception that the Compliance Office is more approachable

32. Utilizing And Leveraging Relationships With Your Physician Champions • Be the Physician Champions’ advisor on macro level issues • Major changes or proposed major changes that will impact their area or the entire organization • Be the Physician Champions’ consultant on micro level issues • Know their specialty and issues that impact their area • Be their consultant for complex compliance issues • Involve the Physician Champions in education as often as possible when conducting training sessions with their peers Pointers

33. Utilizing And Leveraging Relationships With Your Physician Champions • Capitalize on how this approach can mold and shape your culture • Leverage this relationship to network, engage, and build relationships with other physicians • Utilize the Physician Champions to make the Compliance Office more approachable • Utilize the Physician Champions to break down barriers and silos Pointers

34. Utilizing And Leveraging Relationships With Your Physician Champions • Don’t overload or overwork your Physician Champions • Don’t leave them on their own without your support-they need it • Your Physician Champions expect you to be the compliance expert they can turn to for help • Give them the same level of expertise and perfection that you expect of them Pitfalls

35. Pointers And Pitfalls In Gaining Physician Buy-In To A Compliance Program • Interacting with physicians • The ability to understand their focus and avenues to relate or communicate is critical. • Building physician - compliance office relationships • This is critical for the success of your Physician Champions program as well as for the overall success of your compliance program Conclusions

36. Pointers And Pitfalls In Gaining Physician Buy-In To A Compliance Program • Utilizing and leveraging relationships developed with your Physician Champions • Tie everything together you have learned from interacting with physicians and building your Physician Champions program to help mold and shape your entire organizational approach to compliance. • Leverage these relationships to integrate compliance into their daily routine • Utilize these relationships to network and continue your “Compliance Grass Roots” movement Conclusions

37. Pointers And Pitfalls In Gaining Physician Buy-In To A Compliance Program Questions?