“This three-pronged strategy focuses on educating patients and staff about how to avoid misconduct. It also emphasizes training individuals on how to recognize and report FWA violations when they see them.”
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The OIG’s Beneficiary Inducement Final Rule is part of HHS Regulatory Sprint to Coordinated Care – Advancing the transition to value-based care.
Continue readingHow can you protect personal health information (PHI), medical records, and patient communication when the provider is also the patient?
Continue readingInformation Blocking Rule works with HIPAA’s regulatory “right of access” provisions. Patients should have access to their health information.
Continue readingRecent changes to Stark aim to increase coordination of patient care, modernize, and clarify rules related to the law.
Continue readingPatients and providers alike flocked to telehealth in 2020. Before the COVID-19 pandemic began, fewer than one percent of Medicare primary care visits (PCV) were conducted via telehealth. By April 2020 that number had risen to 43 percent. (See the data.)
This spike was in response to fear of spreading the virus, of course. But it was only possible because healthcare organizations worked so hard to adjust to meet the ongoing patient needs. The federal government helped by announcing a public health emergency that eased key rules.
Related: Differing state regulations make telehealth compliance more complex.
Compliance professionals worked across their organizations to make sure that everyone understood and complied with documentation, coding and confidentiality requirements. For example, compliance professionals collaborated with clinical teams to ensure telehealth workflows were HIPAA compliant. And, given the potential for abuse and scrutiny, providers who bill Medicare/CMS took extra care to document visits properly.
Telehealth has been hugely popular with patients and has led to better visit compliance, particularly for uninsured and underinsured populations. Telehealth has improved patient care by allowing convenient appointments from the comfort of home via a smartphone, tablet, or computer. Another benefit is that telehealth has the potential to expand health care access to underserved populations by eliminating traditional barriers to care such as transportation needs, distance from specialty providers, and approved time off from work. These visits were essential for patients with limited mobility. And of course, there’s the most immediate and urgent benefit of telehealth: reducing the spread of COVID-19 by limiting person-to person-contact.
The work for the Compliance team and colleagues across the organization was significant. They had to determine how to maintain confidentiality, obtain consent, and determine proper billing codes. Despite the enormity of this task, the effort seems to be worth it. Patients are reporting that telehealth helps them take better care of themselves. According to Medical Economics:
Providers seem to feel that they have worked through a lot of the challenges of telehealth compliance, especially when internet connections are stable. Nicole Craig is a Family Nurse Practitioner at Children’s Rehabilitative Services in Phoenix. She says compliance guidance helps providers “know what has to be documented in the chart to protect ourselves from things such as improper billing and coding.” And, “in 2021 the billing is now different. Getting help from Compliance allows providers to bill time-based care. We have to understand the billing rules and compliance factors in order to follow them, especially during telehealth visits.”
For most PCVs, telehealth proved to be an efficient way to provide care. This method limited in-person visits to those instances where the patient needed a hands-on physical assessment or diagnostic testing.
Isabella Porter, JD, director of Compliance at District Medical Group, Inc., is confident that 2020 created a rebirth of telehealth. She also sees a new appreciation of this method of care delivery which healthcare will not abandon once the pandemic is deemed “over.” And she knows that her team will be a big part of her organization’s success. “I do believe that in the context of telemedicine during COVID-19, our Compliance department’s assistance with telehealth workflows lead to overall better patient outcomes during the pandemic,” she said.
It’s a good thing. While concern about the coronavirus will recede, providers and patients alike will want to continue some telehealth visits. Healthcare leaders will work collaboratively to ensure their organizations can continue to offer this important option.
Keep on top of regulations affecting telehealth and make sure those regulations are translated into policies and procedures that affect patient care. YouCompli customers have access to notifications about changes to regulations, resources to inform policy and procedure updates, and tools to track compliance. Contact us today to learn more.
Denise Atwood, RN, JD, CPHRM has over 30 years of healthcare experience in compliance, risk management, quality, and clinical areas. She is also a published author and educator on risk, compliance, medical-legal and ethics issues. She is currently the Chief Risk Officer and Associate General Counsel at a nonprofit, multispecialty provider group in Phoenix, Arizona and Vice President of the company’s self-insurance captive.
Denise Atwood, RN, JD, CPHRM
District Medical Group (DMG), Inc., Chief Risk Officer and Denise Atwood, PLLC
Disclaimer: The opinions expressed in this article or blog are the author’s and do not represent the opinions of DMG.
Working toward higher rates of patient medication compliance is a critical component of patient care. That includes communicating what the medications are, what they do, and how to take them. Providers are keen to ensure they provide clear directions and to be sure patients can pay.
It’s no wonder they take such care: Each year, about 125,000 Americans die due to poor medication adherence, according to the American Heart Associationi. Improper compliance practices come with a hefty price tag of $528 billion in annual expenses, according to a 2019 OptimizeRx surveyii.
What’s more, medication mismanagement is a strong predictor of hospital readmission rates. Individuals who failed to take prescribed medication as directed had a 20 percentiii chance of hospital readmission within 30 days, compared to 9 percentiv for patients who take meds as directed. For the compliance officer, keeping hospital readmission rates low is crucial to avoid wasteful spending, per the Centers for Medicare and Medicaid guidelines.
So many factors contribute to whether a patient properly follows through with medication instructions. Providers and administrators alike do their best to put systems and communications in place that make compliance easier. While not within a compliance officer’s direct control, there are policies and procedures that can help hospitals comply with CMS requirements to lower readmission rates. This helps facilitate better health outcomes and increased quality of life for patients.
So how can you ultimately help patients improve medication management skills? Here are a few tips you can include in your medication compliance plan to help reduce readmission rates.
Patients who experience side effects may stop taking their medication altogether; without discussing this decision with their healthcare provider.
That’s why it’s so important for doctors to discuss common and possible side effects with patients.
Work with healthcare providers at your facility about how they can discuss any treatment plan changes to lessen the chances of side effects. Make it known that the treatment plan may include adjusting the dosage or changing the medication altogether. Cut Out Distractions
According to BMC Health Services Researchv, three out of five patients often forget to take their medication.
Are distractions the main culprit? Encourage providers to discuss the importance of taking meds at the same time each day.
Maybe patients can use a cell phone alarm to set up reminders. Taking multiple medications at different times? The workaround may be to set other alarm times for numerous times during the day.
To make things even easier on patients, providers may consider prescribing once-daily medications.
Providers may consider collaborating with the patient on the best time to take the medications when distractions are at their lowest.
Sometimes the issue of medication compliance comes down to cost. About 70 percentvi of physicians link high prescription costs to a lack of medication adherence.
To save money, they may ration meds or not take them at all.
In a study published in Circulation, viione in eight patients with heart disease didn’t take prescribed medication because of the expense.
Luckily, there are resources such as GoodRx, an app that allows anyone to shop at local pharmacies for the lowest prescription medication prices.
Doctors can also prescribe generic versions of meds whenever possible to cut back on costs.
Poor communication is a deterrent to medication compliance, which is in turn linked to poor health outcomes.
Fortunately, Motivational Interviewing can help. With Motivational Interviewing, health care providers are encouraged to ask open-ended questions beginning with What, Why, How, and When during discussions about medication usage. This technique is shown to improve behavioral change and adherence, as reported in Perspect Public Healthviii.
This PDF by The Motivational Interviewing Network of Trainers provides more information on motivational interviewing.
Medication compliance helps patients experience better health outcomes, reducing readmission rates and helping the hospital avoid tripping CMS’s indicators for fraud, waste and abuse. While much of the responsibility lies with the patient, hospital policies and procedures can help ensure the patient has the best possible chance to understand and comply with medical guidance.
YouCompli helps healthcare facilities know about regulations, decide if they apply to them, manage policy and procedure rollout, and verify compliance efforts. Learn more
i American Heart Association
ii OptimzieRX survey
iii 20 percent
iv 9 percent
v BMC Health Services Research
vi 70 percent
vii Circulation
viii study