“Let’s Talk Compliance”: Hot Topics in Compliance | Foley & Lardner LLP

Editor’s note: PYA and Foley & Lardner hosted six events^th Annual “Let’s Talk Compliance” two-day virtual conference on January 18 and 19, 2024. Panelists include Foley & Lardner attorneys and his PYA experts.The event was hosted by Foley Partners Yana Kolarik and PYA Principal Angie Caldwell. Below are some key takeaways from session #4, along with links to profiles and contact information for relevant subject matter experts. If you have any questions, please feel free to contact us.

On January 19, 2024, as part of our 6th annual “Let’s Talk About Compliance” series, Foley Partner Jana Kolarik and PYA Principal Angie Caldwell welcomed: matt vogelianHead of Corporate Responsibility, AdventHealth Central Florida Division, and valerie cloud, Summa Health’s chief compliance officer, participated in a panel discussion on hot topics in compliance. The recording and slides from this session (and others that were part of the series) are below. here.

Panelists focused on four discussion topics – (1) the healthcare landscape centered around artificial intelligence (AI), and (2) practicalities for incorporating the Office of Inspector General’s (OIG) General Compliance Program Guidance (GCPG). (3) Compliance considerations regarding collaboration between advanced practice providers (APPs) and physicians; (4) Physician compensation challenges in analyzing physician productivity, subsidy arrangements, and toll charges.

Below are key insights from each of the four discussion topics.

(1) The health care situation surrounding AI.

• Vogelien and Cloud noted that healthcare organizations are at different stages of maturity when it comes to AI policy, governance, and control.
• Vogelien noted that the AI ​​healthcare landscape is rapidly evolving due to the rapid expansion of technology offerings, and noted the policy and governance frameworks available from a number of sources. As one of AdventHealth’s clinical leaders says, “We need to balance innovation with responsibility.” Vogelien emphasized that rather than just implementing the latest and greatest, we need to evaluate the workflows we can improve and the problems we solve, and consider whether there are AI tools that can help us achieve those goals. .
• Vogelien says the best first step is to ensure that AI is integrated into the enterprise risk management framework across the organization, monitor ongoing policy and regulatory developments, and monitor AI strategies, activities, He said it was about tracking tools and identifying an interdisciplinary leadership group responsible for shaping the organization. AI governance and policy. This may include legal, compliance, IT, risk, and clinical leadership.
• Cloud agreed that the landscape of AI in healthcare is rapidly evolving, presenting both opportunities and challenges. Organizations should critically evaluate AI solutions to ensure alignment with their specific needs and understand the potential impact on workflow and patient care. While there are great expectations for the integration of AI, we believe that AI requires a thoughtful approach to address challenges related to privacy, ethics, patient safety, federal and state regulations, and education. she pointed out. Realizing the full potential of AI in improving patient outcomes and healthcare delivery requires a collaborative environment involving healthcare professionals, technology developers, and policy makers.
• Panelists agreed that each organization’s approach to incorporating AI into its operations will vary in type, pace, and scope based on the organization’s size and needs. As AI evolves, the governance surrounding such incorporation will become important for compliance.

(2) practical considerations for incorporating GCPG;

• Cloud explained how important it is to recognize that GCPG is not a one-size-fits-all solution or a one-stop shop. Each organization must tailor its approach to its unique structure and specific risks. Flexibility and adaptability are key, as compliance frameworks must be customized to address the complexity of an organization’s compliance environment.
• Cloud emphasizes the importance of continually evaluating and evolving your compliance program as your organization grows, and recommends sharing key elements with various committees and stakeholders. It is especially beneficial to establish channels to receive feedback from employees and stakeholders regarding the effectiveness of your compliance program. This ensures that your compliance strategy responds to real-world challenges and dynamics within your organization. Regular evaluation of your compliance program is essential to identify areas for improvement and maintain alignment with GCPG.
• Cloud also noted that fostering connections with other professionals can be beneficial. Building a network of professionals allows for engagement and the exchange of ideas, allowing for continuous learning and improvement in compliance practices. This collaborative approach strengthens your organization’s ability to stay informed about best practices, industry trends, and potential challenges, ultimately contributing to the overall effectiveness of your compliance program.
• Mr. Vogelien commented that the GCPG contains many useful updates and recommendations that can inform considerations for assessing the current state and improving compliance programs.
• When discussing the GCPG, Vogelian heard several compliance professionals say, “It’s actually a lot of the same thing, albeit in different formats.” Vogelian advises against falling into that trap. Although many of his excellent GCPG summaries are available at this time, he recommends that compliance officers read the guidance in its entirety and take note of the salient points, taking into account any specific considerations for the program being evaluated. doing. The result of this exercise will probably be 1-2 pages of notes and ideas.
• Vogelien further said that when speaking about compliance program effectiveness and new industry updates such as GCPG, he shares the concept of compliance program effectiveness planning. He recommends developing a continuous improvement or strategic plan for your compliance program. There is no scientific basis for this, but it could be a three-year plan or a five-year plan. The idea is that the plan is organized around the “seven elements” of an effective compliance program. Based on specific government or industry guidance and regulatory changes, the program’s current “maturity” level, and compliance resources and staffing, organizations can prioritize areas of focus to implement, change, and implement over time. or can be strengthened. You may strengthen your compliance education program next year by prioritizing and focusing on some of the areas highlighted in this year’s risk assessment.
• The panelists mentioned key points from “.“Let’s talk about compliance” Session #1, agreed that it is important to evaluate how to customize the incorporation of GCPG into an organization’s compliance work plan. Each organization’s focus will be on specific facts and circumstances.

(3) Compliance considerations regarding Advance Practice Provider (APP) and physician collaboration.

• Kolarik noted that this hot topic continues to evolve due to complex and ever-changing guidance regarding split shared visit billing and regulatory considerations regarding physician self-referral laws and anti-kickback laws.
• Panelists agreed that continuing education is important as practice patterns for physicians and APPs change.
• Vogelien pointed to the importance of physician coding and revenue integrity experts and auditors. It is best practice to proactively educate the physician and her APP about various collaborative care models and current clinical documentation requirements. Education must also be updated as instruction changes. Auditing such collaborations should also be part of your compliance work plan. If you don’t have the in-house resources or expertise to do this in-house, there are options and companies available.
• Cloud commented that the collaboration between APP and physicians highlights the need for a thorough approach that focuses on professional awareness and educational efforts. It is a best practice to conduct ongoing audits related to this collaboration to ensure compliance standards are being followed.
• Cloud further added that successfully addressing compliance considerations in APP-physician collaborations requires a multifaceted strategy, including promoting professional awareness, implementing educational initiatives, and conducting regular audits. He said all of these are essential elements of a strong compliance framework. By prioritizing continuous learning, transparent communication, and proactive monitoring, healthcare organizations can create a collaborative environment. This not only ensures compliance with standards, but also enhances the delivery of quality patient care.
• Mr. Caldwell shared a case study on the impact of APP with attendees, demonstrating the impact that APP and physician collaboration can have on the underlying compensation plan.

(4) Physician compensation issues in the analysis of physician productivity, subsidy arrangements, and call charges.

• Caldwell believes that as pay-for-performance and value-based reimbursement continue to increase, analyzing physician productivity in terms of metrics other than productivity in relative value units of work will become more important in the future. He pointed out that it would happen.
• Mr. Kolarik highlighted the complexities of subsidy arrangements, particularly as they relate to ensuring that the underlying provider remuneration is at fair market value and that the costs applied to subsidy calculations are commercially reasonable. He pointed out that
• Mr. Cloud echoed the insights shared by the panelists, adding that, as the healthcare industry continues to move towards value-based reimbursement, taking a nuanced and adaptive approach to physician compensation He commented that this is important. To effectively meet the challenges in this evolving landscape, healthcare organizations must expand their metrics, adopt value-based models, and regularly reevaluate their compensation structures. This proactive strategy can help organizations successfully navigate physician compensation challenges and ensure alignment with the dynamic trends shaping the industry.
• Regarding subsidies, Mr. Vogelian shared that post-implementation adjustments are also important to ensure that agreements are implemented as intended, assumptions apply and fair market value is maintained.

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