A recent panel discussion I moderated with two compliance officers shed light on how they are meeting the challenges of healthcare compliance through the COVID-19 pandemic and how it is shaping future plans for their organizations.
Our speakers were Tina Tolliver, Chief Compliance, Ethics & Risk Officer/Privacy Officer at Millennium Healthcare and Mark Nue, Compliance & Privacy Officer at Alta Hospitals Systems. Here are some excerpts from the discussion, highlighting their insights on two of our polling questions.
Our first audience polling question: What is your number one personal challenge currently?
Tina Tolliver: We're not working in the 8-to-5 environments anymore. And so we find ourselves working at all hours of the day at all times. Where is that fine line that we're trying to separate ourselves from? Even on the increased workload part, I know that it's at that 33 percentiles. The Health Care Compliance Association and the Society for Corporate Compliance and Ethics (SCCE) did a survey in June of over 300 compliance professionals, and the summary came back and said the two worrying signs that they had were budgets and the increase in inquiries.
This is a challenging time. And so, when do you, again, balance that workload? When do you work and when do you kind of relax? And I think that's something that we're still struggling with.
Mark Nue: The word balance incorporates all the previous selections because when does work start and end is a blurry line now. Where physically leaving your office would give you that shift, now it's a matter of walking out of a space that you would normally use, personally, anyway.
And the other piece is, perhaps, sharing a workspace with someone else working from home that wasn't always there. I didn't realize how accustomed I became to working alone in the office. The smallest sound, I would be looking at it trying to figure out what’s that about? So, learning how to work on my focusing skills became readily necessary.
Second polling question: Has the impact of COVID-19 caused a reduction (layoffs) in your compliance staff?
Marcy: Mark, have you had to navigate layoffs and changes to your team’s structure?
Mark Nue: We're in the last category at 69% so far because we have had furlough days and PTO, and it's not reduction on a permanent basis. But it is sort of slowing things down to help accommodate the financial stress the organization is going through. And this has been at all levels of the organization. Not just compliance.
But our other safeguarding departments of audits and revenue integrity and different folks who aren't direct caregivers, everyone's got to give what they can. Our organization has taken the approach of, let's try not to have any reductions in workforce unless they're necessary. And we'll try the furlough piece to the extent we can. And what we don't know, we don't know.
Marcy: Tina, what are you seeing in your area?
Tina Tolliver: We have a completely different picture. We had to reduce by about 33%. So that impacted my department ever so much. We had to retool some of our policy procedure management individuals and had to shift that work. Our incident management team was converted over to now having to process all the COVID incidents coming through, and we were being inundated with those.
A lot of the work that we were already doing was now in higher demand and coupled with some of the other incidents that were coming through because of the COVID-19 situations. We've been working hand-over-fist with each other and just trying to navigate to who's going to do what on which day. And, we're cross-training ourselves more and more. But what do you do? You dive in, and you get it done.
We're wondering, again, what we can place on hold. Some of the things we were normally doing would be some of our risk assessments and policy and procedure reviews and things like that – that we had to put on the back burner.
But at the same time, you have to prioritize, and almost risk-rank your work. And so that's kind of what I had to do from a leadership standpoint is just determine what we can get by with to be able to get through this period of time. It wasn’t easy. One of the things that I did is put together a quick way to have those high-end policies and procedures at the ready.
So, I could distribute them, or provide them when people ask for them. I was trying to be more of a responsive resource, as opposed to saying go out there and find it. Again, people are on edge and need to get to certain information.
I wanted to make sure that I was sitting there at the ready – but that's not something that I had done in the past. As the Chief Compliance Officer, I was “boots on the ground.”
Marcy: Do you have any additional thoughts around some of the other impacts that you've seen from a compliance perspective?
Mark Nue: So when we got the work-from-home order, which came in mid-March, in my area on Saint Patrick's Day, it was kind of go virtual, get the things that you're going to need. And at that point, they said two weeks. I immediately transitioned my compliance committees to Microsoft teams. I was thinking to myself this is going to be a bit of a challenge.
I was concerned about engagement about being able to read the room and encourage dialog. That’s typically easier to do in person.
And the online platform actually has gone very well, and it helps the folks who are in different areas of the facility or maybe do work at off-site locations participate in a much more even way. But to engage electronically has gone much better than expected, and that's nice.
The other full shift was our online learning. Prior, we had an in-person training for new employee orientation that I would provide. And we've always had an online learning system that we used, sort of as a backup. But we shifted to fully 100% online. And I think that's gone well.
I certainly like having the reports ready for completed training, rather than kind of looking for sign-in sheets and different other manual processes. So, it’s really supercharged the use of some of these technologies that we had but maybe weren't fully leveraging. So it's been a positive on that level for sure, unexpectedly so.
Tina Tolliver: As far as the staffing goes, having that cross-training and individuals in my department being able just to pick up where another person left off or where we had to fill that need – that was a huge piece. That's something I had always done in the past when I've managed teams, and I really hadn't done that with this organization over the last few years. I'm building the team and trying to get the specific talent, skills, and expertise into certain roles, but now I had to cross them over, which ended up being very beneficial for the entire organization and for us going forward.
Because now we're going to be able to act on all kinds of different issues and items that come into the compliance office. And that cross-function has been huge for us, and I think going forward having that within your compliance team is going to be key.
With the regulations changing, one of the things that I did is “lock arms” with our outside counsel.
I’ve seen many webinars and newsletters that are getting out there, and there's information overload to a certain degree – but it's important to get that legal perspective to interpret things like the CARES Act, as far as going through it and seeing exactly how it would affect your organization. Every single day, there was something else coming out and you had to be at the ready to be able to interpret that information. Our team is called a Rapid Response Team, and luckily, being here in Florida, we have to be prepared for hurricanes. So, we already had that framework established.
We were able to put that business continuity team together in a rapid-response fashion, making sure that compliance was there. Because of all the things that came through as far as all the regulations and the issues around patient privacy, I was sitting at the table so, I could, again, address those things, so there wasn't misinformation.
We were meeting every single day at noon just because of all the regulatory changes. Maintaining constant contact throughout a crisis and then going forward might be something that you even want to do with your team just to have that checkmark again.
Marcy: Mark, did you have something like that?
Mark Nue: Yes. Daily calls, for sure. The daily briefing calls down to how many masks we have left, how much PPE count, and what we see trending, how we are monitoring staffing, and who's calling in. We did see increased calls to the hotline regarding “it's not fair that we're not getting this and another department is.” And, in my feedback and my encouragement to leadership, it was to communicate with your staff about what you know about supplies and preparation that our frontline staff may not have.
So, be there for them, and communicate often and early with the status of things and validate them. This isn't easy. This is tough stuff. This is a once-in-a-lifetime kind of experience.
One of our biggest challenges around regulations is, “how do we do what we do now that telehealth just exploded?” CMS said, go do everything wherever you want.
And I'm being a little silly, but can you make a patient's home a provider-based clinic, then just bill for it like you always did, just send a letter in? For those of you who dealt with that, our heads were exploding. Because the provider-based clinics have always been a very delicate compliance monitoring space. Are you doing all the things you're supposed to?
And now they just sort of opened up the opportunity to do it everywhere, which is great for patient care but not so great from how do we do it and what does it look like in the regulations as they continue to unfold and develop over time. Thus, telehealth has been especially interesting for us. And when we got to a place where I think we can do this, we then realized, well, a lot of our patients aren’t in a space where they have technology that would help them participate in telehealth.
So if you build it, will they come?
Maybe not so much. Is it worth building, or how do we shift or what’s in-between or what makes sense in the new world or the new temporary world? And by all accounts, telehealth is kind of going to stay around, and certainly in a permanent fashion.
With reporting, I would say half of my reports to leadership and the board has included what hasn't changed. You know, HIPAA is still HIPAA, we still respect patient privacy, keeping records safe. Not respecting patient rights around their health status didn't change. Some HIPAA regs did allow for sharing them, but that was in a very limited sense, not the basic HIPAA. So, the basic blocking and tackling are very much in play. And then talk about the changes that might come to start waivers, and how we can do certain things. I would include “old compliance” and “new compliance” in my reports and try to keep it as succinct as possible.
Because certainly, a lot is going on, and the frontline workers and the caregivers really are the heroes in all this. But they need to understand that we can't just take off all the guardrails and safety features.
Tina Tolliver: As far as the creative reporting and the patient privacy part, it’s something that we utilize with our SAI Global software. We had our incident management system. We built our workflow around the entry of all of our positive COVID patients. Then, we turned those positive patients over to our patient privacy protection software and were able to protect that patient’s information and track who has access to it. That creative reporting and being able to put that into play with the incidents module was very valuable.
However you can get creative with the tools that you have is going to be key moving forward. We wouldn't have been able to do this if we hadn't had open minds open and had those conversations at that daily meeting. Again, these impacts were great, but if you get a little bit creative, I think you can work through them.
Replay the full webinar on-demand to hear the rest of the conversation – Roundtable: Return to Office, Healthcare Compliance Edition
- Read Part 2, with a discussion about results from the webinar's additional polling questions.
- Read part 3, focusing on the adjustments and updated priorities of healthcare compliance teams.
- Check out our infographic summarizing poll responses during the webinar.
See additional resources and insights from SAI Global for managing healthcare compliance during the pandemic.
Learn more about our risk and compliance solutions for healthcare and health insurance organizations.
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About the AuthorMore Content by Marcy Utley