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Compliance 201KeyComplianceProgramMetrics

CindyMatson,BS,CHC,CHPCVPCorpCompliance,SanfordHealthRuthKrueger,MS,RRT,CHC

CorpComplianceProgramManager,SanfordHealth

Objectives

Review elements of an effective Compliance Program Yates memo DOJ Compliance Counsel

Discuss measurement tools – what are the metrics? Identify key performance indicators as guidelines for resource

allocation What are your program goals – baby steps? What does an effective program look like?

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What are the Measures that Matter?

7 elements – basics still very important

Compliance 201 steps it up Show program is more than words on paper

Tells the story of your program

Objective, data driven information

Compliance as strategic advisors

Roy’s Words Roy Snell SCCE Blog

“A compliance program is not a complex concept. All the elements are quite simple concepts that everyone can understand (i.e. hotline, auditing, monitoring, education, etc.) What is difficult is making sure all elements of a compliance program are working at all times. The tough part of compliance is the coordination of multiple compliance efforts and filling the gaps.”

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Other Perspectives

https://www.youtube.com/watch?v=hseKD9QY8Wk

Effectiveness 101 -7 Elements

Policies, Procedures and Standards of Conduct Compliance Program Oversight Training and Education Communication Auditing and Monitoring Consistent Discipline Corrective Actions

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Compliance Effectiveness 101

Understand OIG Compliance Program Guidance

Utilized key performance measures i.e. Toll free HOTLINE – anonymous, no retaliation, confidential

Treat complaints seriously

Investigate

Close the loop with the reporter

Impose sanctions

Effectiveness 201

What are the measuring sticks?

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201 DOJ Effectiveness

Do directors and managers offer strong support for corporate compliance policies?

Do compliance personnel have stature in the company?

Do the compliance teams get the resources they need?

Are compliance policies clear and in writing? Are they easily understood and translated?

201 DOJ Effectiveness cont.

Are the compliance policies updated & effectively communicated to employees? Are they easy to find and do employees get repeated training?

Are there ways to enforce the compliance policies and is compliance incentivized and violators disciplined?

Are third parties informed of compliance expectations?

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201 Yates Memo

Turn over information on individual wrongdoing = Cooperation Credit

All investigations, both criminal and civil, start with individuals within a company

Assign both criminal and civil lawyers on corporate cases who will share information freely

No individual protection without DOJ approval

Individual actions must be resolved before corporate actions can be resolved

Civil actions against individuals will be pursued even if they can’t pay a substantial fine

Trouble

Headlines…

DOJ Reports 80 Percent Civil Fraud Recovery as a Result of Whistleblowers

CIA Columbus Regional Healthcare System

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201 - New Hire Hui Chen

DOJ Compliance Counsel Responsibilities:

Review effectiveness of compliance programs under investigation

Develop appropriate program benchmarks & remediation measures

Guidance on Fraud Section assessments of a company’s required compliance and remediation efforts

DOJ Goals

Place accountability on the individuals who perpetrated the wrongdoing

Deter future illegal activity

Hold appropriate party responsible for their actions

Promote the public’s confidence in our justice system

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Effective Culture

Is the tone at the topStrongVisibleExplicit

Does the compliance team have:StatureFundingResources

Effective Governance

Principles are in writing

Easily found

Understandable

Translated

Reviewed and updated often

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Effective Education

Are your training and communications directed at service lines and compliance risks?Delivered frequently/bursts of information

Provided to 3rd parties

Practical – Instruct what to do and who to call

Do you benchmark education completion rates?

Good to Great-Risk Assessment

101 Effectiveness Protective Checklist Reactive Event driven Question everything Fear/Sky is Falling

201 Effectiveness Expansive /Service line involvement Dynamic Proactive/monitors Mission/Strategy driven Consider everything Analytics/precision

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Chicken Little Syndrome

Accountability/Disciplinary Action

Does your organization consistently and fairly

Reward good behavior

Punish bad behavior

Hold 3rd parties accountable

Hold service lines accountable

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Plan Your Indicators

Hard to go backwards

Identify goals

Benchmark

Identify areas for improvement

How to Measure

Plan how you will report what you measure

Informative aide in decision making

Clearly delineate the metrics you choosemeasurable, meaningful, quantifiable, predictive

Limit what you measure

Select only metrics that offer quantifiable information

Set thresholds and goals

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Are You Effective?

What do your trends show?

Benchmarks

Employee survey

Compliance team autonomy

Compliance effectiveness review and dashboard

Ideas for Indicators

Audit your audits

Evaluate Reporting Mechanisms

Assess Organizational Culture

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Consider Employee Survey

Employee awareness of compliance resources

Employee’s opinion of manager’s ethical leadership/tone from the middle

Is employee comfortable reporting misconduct

Does employee feels pressure to commit misconduct

How to Report

succinct

meaningful

actionable

timely

visually engaging

organized

Refine type and level of information pertinent to audience:

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Data Overload

Be careful about data dumping

Combine metrics to give good overall look

Less is more

Audit the Audits

0

10

20

30

40

50

60

70

2013 2014 2015

CAP w major findings

CAP w minor findings

No Findings

Total audits/FY

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Repayments Related to Audits(exclude RAC)

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

$160,000

2013 2014 2015

MAC

Medicaid

Other Gov't

Audit Financial Impact by Market

$0

$100,000

$200,000

$300,000

$400,000

$500,000

$600,000

Market 1 Market 2 Market 3 Market 4

FY2015

FY2014

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Audit Closure

FY 2015

CAP w major findings (n8)

CAP w minor findings (n20)

No findings (n32)

Open (n3)

Work Plan Completion

Audit Risk Area Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun FindingsEmployee Licensing High ALL X Minor w/ CAP

340B Pharmacy+ High Pharmacy X Minor w/ CAP

Provider Based Status High Hosp/Clinic X Minor w/ CAP

Provider Licensing High HSDMedical Director Pmts High HSD T

LTC Personal Funds Mod LTC Minor w/ CAP

DME PMD Mod DME X Minor w/ CAP

Research Billing Mod Hosp/Clinic X Minor w/ CAP

Wound Care Mod Hosp/Clinic X Significant

Medical Device Credits Mod Hospital X Significant

Rural Health Clinics Mod Hosp/Clinic X Minor w/ CAP

*Added mid-cycle+External AuditScheduledX = CompletedT = Tentative completion

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Benchmarking

0

50

100

150

200

250

300

350

400

450

500

2013 2014 2015

Vol

ume

of c

alls

Trended Hotline by Category

Total

Privacy

Compliance (coding,billing)

Ethics/HR

Other Risk,Quality, Vendor

Culture

0

2

4

6

8

10

Awareness ofcomplianceresources

Manager ethical Reportingcomfort

Pressure tocommit

misconduct

2013

2014

2015

Rates question on 1-10 scale

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Compliance Programs that Work Roy Snell SCCE blog 12/12/15

…Compliance programs work because they are simple, elegant, and effective. Many people want to make compliance programs complicated, but when they do, they ruin their effectiveness.

Compliance programs work because they are the obvious solution with a purpose to prevent, find, and fix ethical and regulatory problems.

Questions?

Cindy.Matson@sanfordhealth.org

Ruth.Krueger@sanfordhealth.org

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