In this presentation, we cover coming changes to Stark Law, turning your hospital's board of directors into compliance advocates, tracking time for medical directors and more!

1. 1
WHAT YOU NEED TO KNOW FROM HCCA’S
2019 COMPLIANCE INSTITUTE
MAY 2019

2. Nice to meet you
Allison Pullins
• Experienced healthcare technology
executive with 12+ years in industry
• 200+ hospital/health system clients
• Hosted 60+ educational webinars
• Published author, including Becker’s
Healthcare
• Volunteer and fundraiser for The
Marfan Foundation
Loves: black coffee, Fraiser re-runs,
pre-dawn exercise
Pet peeves: dirty refrigerators, whining,
temperamental thermostats
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3. 3
Today’s agenda
• HCCA 2019 Recap
• What we learned from
CMS and OIG
• Key takeaways and best
practices for physician
contracting and
compliance

4. • Despite diminishing returns over the
past few years, the US Government
recovers billions of dollars from
pursuing healthcare fraud
• While the trend these days is
towards reducing regulatory burden,
you can’t skip steps on compliance
• Sessions on Stark Law, AKS, and
FCA are still heavily attended; all
healthcare organizations face huge
risks if physician arrangements are
fraudulent
• At the end of the day, there are
perennial best practices for
physician contract compliance
4
HCCA Recap

5. 5
LESSONS
FROM CMS
AND OIG

6. 6
Kimberly Brandt, Principal Deputy
Administrator for Operations
• Key Takeaway: simplifying
regulation and focusing on
clinical care through a regulatory
sprint
• ”Patients Over Paperwork”
program
• Simplifying documentation
• MyHealthEData
• …and Stark Law updates
From CMS

7. 7
From OIG
Joanne Chiedi, Principal Deputy
Inspector General, HHS
• Key Takeaway: compliance plays
a key role in our evolving
healthcare system
• Be nimble
• Prioritize continuously
• Meet and collaborate with
other key executives
• Form strategic partnerships

8. 8
KEY
TAKEAWAYS
FOR
PHYSICIAN
CONTRACTING
AND
COMPLIANCE

9. Healthcare fraud is a key priority
• Prosecuting healthcare
fraud produces significant
yield
• 4:1 ROI for the US
Government in 2017
• Stark Law, AKS, and FCA
key statutes for hospitals
and healthcare
organizations
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10. 10
Establish policies, protect yourself
• Organizations who in good
faith establish compliance
programs will be looked at
more favorably while under
investigation
• Institute and follow consistent
policies and procedures for
physician contracting
• A firm and well-executed
policy is the bedrock of your
risk management strategy

11. 11
CIA’s model best practices
• All CIA’s are publicly
available
• Key components appear in
nearly all CIA’s
• These components, taken
together, outline the
structure of a best-in-class
compliance program

12. 12
Today’s highest-performing
healthcare organizations use an
active, dynamic compliance
program to harness the
benefits of innovation while
minimizing risks.
For physician contracting
programs, this means:
• Evolve as your needs change
• Harness technology
• Use your expertise in risk
management to create
policies and procedures for
physician contracting
Compliance can drive healthcare innovation

13. • Last summer, CMS issued
an RFI asking for input on
reducing burden/impact of
Stark Law.
• In 2,600+ comments, Stark
Law was one of the top
areas of frustration
13
Stark Law changes on the horizon

14. “We need to change the healthcare system so that it puts value
and results at the forefront of care, and coordinated care plays a
vital role in this transformation. Reviewing the Stark Law
regulations is an important step forward to building a value-
based system, which is one of Secretary Azar’s priorities at HHS.
I am personally leading our recently launched Regulatory Sprint
to remove barriers and help providers deliver the best team-
based care. We welcome public input to get us there.”
-Deputy Secretary Eric Hargan, HHS
14
Stark and the regulatory sprint

15. • Expect announcement this
summer
• We’re speculating, but don’t
expect major changes
• Changes likely will be to
accommodate value-based
payments
15
So…what’s ahead?

16. • In most cases whistleblowers are
neither greedy nor vindictive; they are
quite often high performers with
positive feelings about their jobs.
• When they raise an issue, they do so
believing the organization will be
responsive
• The vast majority of whistleblowers do
not immediately choose the “nuclear
option” of blowing the whistle
• Believe they are fulfilling their
institutional role by escalating their
concerns to a lawsuit.
16
Whistleblowers aren’t who you think they are

17. 17
• Document all interactions
relevant to the investigation;
keep informer updated
• When you’ve reached your
conclusion, review it in person
with the informer, and explain
the reasoning
• Whether the allegation is
valid or not, you have
responded reasonably,
Best practices for conversations

18. Your Board of
Directors MUST think
like compliance
professionals
18
Engage and educate your board

19. • Meet annually to discuss
physician arrangements
• Use dashboards for total
expenditures and compliance
risks within physician
contracting
• While it’s inefficient to have your
board involved in every
compensation decision, it’s best
practice to involve them in
crafting policies and procedures
19
Potential board involvement for contracting

20. 20
ü Does your Board have access
to compliance expertise?
ü Do they complete mandatory
and periodic compliance
training
ü Is your board actively asking
about compliance risks in the
decision-making process?
ü Do they have the information
they need to ask tough
questions?
ü Do they feel your compliance
program effective? Why or
why not?
Board checklist

21. They’d rather spend their time with
patients—of course!
Most physicians do recognize that
time is money, and the fact of the
matter is that different services
performed by physicians have
different monetary value.
Ultimately, administrative time
must be tracked in order to reduce
compliance risk.
21
Physicians don’t like to track time…

22. 22
…While tracking time is a MUST
• Time must be tracked to
ensure payments are made
only for duties outlined in the
contract
• A low or reasonable hourly
rate could mask an
unreasonable number of
hours worked
• Benchmarking hours matters

23. • Mobile devices and other technologies
have made physician time tracking less
of a burden for everyone
• Leveraging these technologies can take
time, effort, and money but it’s well
worth it
23
Time tracking has never been easier

24. Define compliance processes and policies
• Set standards for commercial reasonableness and fair
market value, such as:
• Define what appropriate market ranges for payment are; obtain from a
consistent, high quality source
• Definite limits that require extra documentation or external review
• Internal review and approval process
• Benchmark documentation
• Chain of command
• Board approval
• System for negotiations and renewals
• Notification far enough in advance to address issues
• Review to identify problematic contracts
Key is to have an approved and consistent policy and
process for contract review and approval
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25. 25
ABOUT
MD RANGER

26. 300+ Physician Benchmarks
• Call coverage rates
• Medical direction payments
• Administrative and leadership
• Hospital-based service stipends
• Diagnostic testing, etc.
• Clinic & hourly rates
• Telemedicine rates
Online Platform
• Benchmark lookups
• Contract proposal tools
• Contract reports by facility and
service
• Total facility costs + benchmarks
Research and Support
• Resources for education and
training
• On-call experts to help
subscribers use benchmarks
and tools
Compliance Documentation
• Contract-specific FMV
documentation reports
• Reports to assist with real-time
monitoring and annual reviews
26
Our platform

27. Standardize
processes
and rates
Document
FMV
Access 300+
payment
benchmarks
Review and
monitor
contracts
Have data-
driven
physician
negotiations
Mitigate
compliance
risks
27
The foundation of your contracting process

28. 28
Our database

29. • Call Coverage (55+)
• Medical direction (85+)
• Hospital-based services (20+)
• Administrative (12+)
• Medical Staff Leadership
• Diagnostic/other services
e.g. ROP, autopsy, dialysis
• Hospital-based stipends
• Clinics, professional services
• Telemedicine
• Residency/teaching/GME
• Uncompensated care
• Meeting attendance, peer review,
IT/EHR and quality initiatives
• 13 Pediatric services, with more
emerging each year
Hospital-characteristics drill down
for ADC, bed size, trauma status,
urban/rural, stroke centers, and
more.
Used in such diverse settings as
academic medical centers,
integrated delivery systems, and
critical access facilities nationwide
29
Our benchmarks

30. Let’s talk
⁃ Do you struggle with your physician
contracting policy and strategy?
⁃ Are you spending too much on FMV
opinions?
⁃ Do you think your organization could
become more efficient with access to a
streamlined platform with benchmark
lookups and autogenerated reports?
⁃ Reach out: apullins@mdranger.com or
650-692-8873