Articles on Compliance Strategies

Featured Health Business Daily Story May 8, 2009

Multifaceted Scenarios Remove Boredom From Compliance Training

Reprinted from REPORT ON MEDICARE COMPLIANCE, the nation's leading source of news and strategic information on false claims, overpayments, compliance programs, billing errors and other Medicare compliance issues.

By Nina Youngstrom, Managing Editor, (nyoungstrom@aispub.com)

Because compliance might seem remote from employees' day-to-day experiences and boring when presented as a series of regulatory mandates, some compliance officers suggest using scenarios in compliance training. Scenarios engage employees, and if multiple compliance issues are embedded in the scenarios, teasing them out may sharpen employees' critical thinking.

"Training has to be interactive and entertaining. Otherwise, the message is lost," says Dean Jessup, an attorney and compliance officer for Ivinson Memorial Hospital, a 99-bed facility in Laramie, Wyo. "When you are going over regulations and laws, most people are not going to be wowed. If people get bored, their minds start wandering. You have to keep them hooked."

All Ivinson employees attend annual compliance training (as well as "re-orientation" every year, but that's now online). Jessup introduces employees to the compliance program, gives a short quiz, explains the code of conduct and then presents the scenarios. Each scenario includes multiple topics from the code of conduct (e.g., billing and coding, conflicts, marketing, quality of care). Jessup guides the discussion as employees brainstorm about the compliance issues raised by the scenarios. Generally, employees are able to identify all or most of the compliance issues in scenarios. "Sometimes they need a little help," Jessup notes.

Here are the scenarios Jessup developed and some of the issues they raise:

Serenity works as the admissions clerk for the emergency department and it is a very slow midnight shift. Two individuals appear at the door, a man and a woman. It is obvious the woman is pregnant. At the same time, Serenity notices a doctor and nurse having a very loud and heated conversation. A doctor is telling a nurse that she is not going to explain anything to the patient or their family, and that they would not understand what she had to say anyway. The nurse storms off in the middle of the conversation and asks Serenity, "What are you looking at? Mind your own business or I'll have your job!" Stunned by his comment, Serenity turns back to see the pregnant woman on the ground in front of her office, rolling in pain, saying she "shouldn't be here because I do not have insurance and have no way to pay for anything." At that point, Serenity notices the woman's water has broken. Meanwhile, Serenity hears another patient tell his companion, "See that pregnant lady? I know her. She was tested for HIV last week. My friend Squeaky works here and he's going to find out the results of her HIV test. He snoops in peoples' medical records all the time and has even sold stuff to telemarketers."

Comments: Jessup wants employees to know that patient safety/quality of care come first. The woman is going into labor and needs to be seen right away. Her insurance status is irrelevant and asking for it before screening and stabilizing her is a violation of the Emergency Medical Treatment and Labor Act. Also, loud arguments between hospital staffers fly in the face of Ivinson's standards of behavior. And it's inappropriate that the doctor refuses to speak to a patient about her medical condition because patients have rights. Finally, patient confidentiality (HIPAA)is violated when Serenity overhears that an employee regularly accesses patient files inappropriately.

Max is a clinical engineer and is working in radiology troubleshooting on an issue connected with a new piece of equipment. He is talking to Sue Jones, a radiology technician, who tells him radiology is doing some really cool things these days. She says she is making a ton of extra money and "it's cool that patients don't have to pay for anything." She goes on to tell Max that one of his friends is in this research program and may not be able to have kids because of the amount of radiation he is exposed to. She also tells Max that she thinks someone may be leaving hazardous materials outside of their required storage area. When Max asks her how she knows all of this, she says, "Lou Sir, the guy who just lost his license, told me to leave them out so they are more accessible." As Max starts to walk away, she slaps him on his rear, winks, and says, "Nice seeing you again, Max!" Max could smell alcohol on Sue's breath, but he thought maybe it was just mouthwash, so he goes about his business. When Max walks by the radiology break room, he notices some unusual bottles and containers, some of which have warning labels.

Comments: The most important message for employees to take home from this scenario, Jessup says, is that Max must talk to his supervisor because he suspects Sue is drinking alcohol on the job, which means she could endanger patients. The scenario also "alerts people to consider that research may be occurring based on Sue's comments to Max," Jessup says. "We then discuss issues of appropriate channels to get approval for research on human subjects, patient safety issues as they relate to research projects and payment issues (inducement) related to research subjects." And there are environmental issues (e.g., hazardous materials outside the storage area), sexual harassment, and patient confidentiality/HIPAA problems (when Sue tells Max that his friend is part of ongoing research).

Art Count works in Accounting and is cruising the Internet, trying to find gifts for his family on eBay. While online, Art notices that his computer is generating a lot of e-mails, which he is not sending. He notices that John Hacker was on his computer and he knows that John has boasted about his computer skills in the past. Art and John have a strained working relationship, especially over the last few months. Art feels like he is having problems with John because the last time they went golfing he asked John where he got his new set of golf clubs. The golf bag was stamped with a local doctor's association name and logo, and John told Art that it was just a gift because he was steering so much business to them. Art told John he thought all of that was against the law, but never told anyone else about this conversation or John's gift.

Comments: For one thing, the hospital's IT people would have to be notified because a hacker (probably John) has messed with Art's e-mail. Also, there has been a violation of the hospital's vendor gift policy. Ivinson has a zero-tolerance policy for gifts from vendors and patients. In the past, Ivinson bought its physicians gifts, such as a small grill set. The price was well below the $355 annual Stark limit on hospital gifts to referral sources. But this year the hospital did something different: It held a food drive and donated the proceeds to charities on behalf of the physicians.

Mary Trustee is a member of the Board. Mary and her husband, who is a physician, own one of three swimming pools in town. At a board meeting, two action items need to be voted on. The first involves giving employed doctors a raise. The second concerns a contract that needs to go out to bid, and it's for the hospital's new aquatic rehabilitation services. Should Mary participate in the discussions and vote on these two items?

Comments: Conflicts of interest are at the heart of this scenario. Though Mary's husband has privileges at the hospital, he isn't employed there, so she can vote on the salary increases. But she can't vote on the vendor contract for the aquatic rehab project unless she opts out of the bidding. "However, under Wyoming law, if she did submit a bid and was selected, the full board, minus Mary, would need a unanimous vote to extend a contract offer," Jessup says.

Billy from the business office comes to you as his supervisor and asks about billing errors. He lets you know that the wrong code is being used for an outpatient procedure that makes it look like an inpatient procedure. He also tells you that one of his co-workers has been throwing away financial records he thinks are needed for the annual audit and cost report. Billy asks you if these two incidents are compliance issues. What do you tell him and how do you handle the situation from there?

Comments: Obviously this scenario addresses billing errors. Jessup emphasizes the importance of detailed documentation when discussing this scenario. It also raises issues of financial reporting and document retention. For example, as hospitals convert to electronic medical records, they eventually can dispose of paper records after scanning them in. But employees shouldn't destroy paper records until checking with their supervisors, Jessup says.

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