Overcoming Compliance Challenges within Academic Health Systems

Good afternoon, everybody. My name is Sean Geddis. I am a territory leader here at ProviderTrust. Thank you all for taking the time today to join us, for today’s fireside chat, overcoming compliance challenges within academic health systems. I’ve got two, I’ve got one esteemed colleague and an esteemed client of ours today, joining us. First of all, our chief compliance officer, Donna Thiel, is going to help us with conversation today, along with, Cynthia Holland, from the University of South Alabama. She is the director of billing compliance. Before we get started, just a couple of housekeeping items. All of your phone lines have been placed on mute, for your own protection, to eliminate any background noise. But if you’ve got questions, I would encourage you to, please use the chat function within Zoom, and, just pop those questions in there, and I will do my best to address those, as we progress. And, we’ve also got some time reserved at the end for, for some q and a. Today’s conversation is being recorded, and we will go ahead and distribute it, in a follow-up email, to everybody that’s joined us today along with a quick case study that, we have, for, another one of the academic, medical centers that we work with. So, as we’re getting started here, Cynthia, I just wanted to say thank you again. I had the opportunity to personally work with Cynthia, as she was looking for, a solution to solve for some excluded monitoring, problems that she was having at the University of South Alabama. And, and again, you were just a joy to work with. We’re always happy to work with, work with with folks like you. And and, and again, I appreciate you taking the time out, today to to to join us and help us out. So. Oh, it’s it’s been, a lifesaver for us and an eye opener. That’s great. That’s great to hear. So some quick, presenter, information. I think we’ve gone through this already. And I wanna go ahead and kinda, I guess, let Donna chime in here, and, talk us through a little bit about, University of South Alabama. Well, let me let me start here with, with with, the health system. So I guess, USA Health, is the only academic health center, along the upper gulf Gulf Coast of, of Alabama. I was doing some some research, Cynthia. You and I had spoken a little bit about, about some of the work that, your physicians and your students do in the community. I was, it was really cool to find that I think you are in, like, the ninety eight percentile, as far as, folks going back to rural communities, and serving those communities, from a from a health care perspective. And I was also delighted to find that I think you’re in the high seventy percentile, with regards to, African American graduates, from the school. So it definitely rings true. You told me how much that, that the university and the the medical center gives back to the community. And and, like I said, we’re we’re lucky to count you as a as a client and a partner. I know today you’ve got about, just over seven thousand clinical and nonclinical staff members, and about hundred and eighty academic physicians who are, both, working in a teaching perspective and and also treating patients. And and and you’ve got you’ve been there about fourteen years, and I and I don’t think this is your first rodeo. No. But, certainly, I I would love it if maybe you’d kick things off by telling us a little bit about, about your time at, at the University of South Alabama. Absolutely. I’m a graduate of University of South Alabama alumni, so that helps, to work for somebody that educated you. So, I really do like that part of it. We have, pretty close to eight hundred providers including APPs, nurse practitioners, physicians, that service our community and our clinics and in Arthur hospitals. We own Providence now. We just acquired it in October of twenty twenty three. We have, University of South Alabama Medical Center, which is now called University Hospital, which is the only level one trauma in the area. And we have a children’s and women’s hospital, and we have a stand alone, oncology facility, which is called Mitchell Cancer Center. So we have a variety of providers, physicians, nurses, practitioners of all kinds, clinicians of all kinds that have any type of license or credentials, and, ProviderTrust has been able to streamline us into checking those license, verifying their, your expiration dates, just anything in their background even if it didn’t have anything to do with when when their tenure here was, but it has been able to, open our eyes to some things that, may help in our reasoning of things that we’re having with, incidents we may be having with, documentation or other compliance issues that shows the history of that provider or those clinicians. So that was not something that we were expecting from provider trust. That happens to be an added bonus. I think that’s that’s, all of our you’ve you’ve touched on this the the clinics. We have, I think, sixty to sixty five different locations all around Yep. The Gulf Coast. We’ve added a few more with Providence over in Mississippi. So we have a a lot. Finished up a big renovation, right, or a big addition? Yes. We did, across the bay in Fairhope, the MAPS center. Yep. It’s we’re we’re trying to reach, I guess, our patients all around the Gulf Coast. We say across the bay, which is, you know, across our bayway, which is over into Fairhope from from Mobile, which tends to have a lot of, wouldn’t say, like, floor Floridians, but, they tend to stay over there, and they don’t wanna drive over here for their physician. So we’re trying to have our physicians go over on that side for one or two days a month or a week or whatever Yeah. The patients seem to need. Sure. Alright. Well, thanks for that introduction. Thank you, Sean. Thanks thanks, Cynthia. So, I saw the title of our our webinar today or our chat was fireside chat, and I was thinking about that this morning. And I was thinking, gosh, that feels like it should be winter, and we should be sitting, by the fire. So I was thinking maybe it’s more of a lakeside chat. Like, we’re just sitting at the lake, right, enjoying the beautiful summer. So we’ll kinda think about a nice breezy, afternoon today. So, as we’ve had the opportunity to get to know Cynthia over the last couple years, I’ve loved our conversations. And I think what is is really special about this conversation is the uniqueness of, an academic medical center. Right? I mean, that’s just we know we have a lot of our clients are traditional providers, but crossing that that, kind of that fine line, right, of an academic teaching hospital, but you’re also providing, you know, obviously, direct patient care. And I wondered if, Cynthia, if maybe we could just start with from a compliance perspective, like, what are some of those challenges that are unique or that you see in being in an academic medical center? Well, it is trying to find out if the physicians or the providers over at the university are actually seeing patients. A lot of times, they have a license. We’re not even we weren’t even aware of them having a license or doing any type of health care at the university, which they do because there’s grants, clinical trials, things like that that that the health care we were kind of in a silo over here and weren’t aware that patient care was even happening at that point, and there are certain licenses, certain credentials that they have to maintain and keep up that we had off our radar completely because, we were not feeding those providers through any of my, manual, exclusion checks with the Alabama Medicaid or with OIG, which were the only two at the time that I I was doing. We weren’t doing Sam or or the other forty two states that of Medicaid that y’all have brought into our world. So, yes, it it there are challenges with physicians seeing patients over there that have nothing to do with patient care really, but that are part of grants and clinical trials. And and, again, they do have to have maintain certain credentials and licenses to do that, and they weren’t on our radar. I don’t know if they were on anybody’s. Right. That’s one of our challenges in compliance. Right? Is there’s data and people in so many different places, and you only know what you know. And if you don’t have, good integrations or good kind of cross functional conversations, it’s hard to know that there’s even something that, that you’re missing or needing to be looking at. So Sometimes you assume someone else is doing it, and they assume someone else is doing it, and no one’s doing it. Right. Exactly. And all of a sudden, there’s an oops, right, where we find out something. We had lots of oops in the in the implementation that we had lots of gaps. So it it has really opened our eyes to be more compliant. Which is wonderful. Wonderful. So if you don’t mind, let’s go back just a little bit, and let’s talk a little bit about kind of the journey that you went through when you’re like you said, right, you you didn’t know there were all these different certifications that different, you know, practitioners needed or, you know, teaching positions that you didn’t even know needed to to be have a license monitoring. So maybe talk a little bit about that journey and and how you kinda set out to find a partner, find someone to, to do this service and and maybe the thought process you went through, how you were, I I hope, lucky enough to meet Sean and, start working with the provider trust team. But maybe just from a education perspective from for a compliance officer who’s sitting in your shoes, right, thinking, oh my goodness. I need to, start this journey, and it feels a little bit overwhelming. Maybe help them think about, like, the the process that you went through and whittling it down and and the kinds of questions that you asked. And and maybe, if appropriate, what bubbled provider trust to the top when you were able to make that final decision? I usually base everything on rapport. I had talked to Sean, several times. I I honestly didn’t know that there were vendors that could do this for you and that it would be adequate and compliant and extensive. So this was a a very good experience for me. I honestly just Googled exclusion monitoring, and there were I looked at I actually had a demo with seven different providers. Couple of them we use for three forty b and other type of con consulting services just like so they were big names, but they couldn’t either they weren’t interested in doing it or I got the impression they weren’t interested in in what we needed or helping me bridge what we needed with what they could provide. I don’t know. Maybe I felt that way or they just didn’t take the time, and maybe I didn’t ask the right questions. So by I kept going back to Sean after I had gone to the other ones, and he just knew more about what I needed than I needed. I told him what I was looking for, and he told me what they could do. And it was, oh, well, we’re not doing that at all, so let’s add that to it. And then we, as a compliance department, started reporting to, legal, which, is usually a no no in the compliance area, but, he was all on board with getting it automated. And he thought it would be worth the money after he asked me how long I spent doing it, which is usually about three days, and it was inadequate, incomplete. But, again, it was back to what I needed and what Sean showed me that they could do, which I didn’t even know we needed. And I wasn’t even aware that y’all could do, other states other than Alabama or that they had exclusions. And we do have nurses with multistate license, which we, you know, that’s all new into this generation. So it was able to check-in other states where they had had licenses, sister states, you know, and so it brought to the forefront that we might be hiring people that were, less than what we needed for patient care, that they had had disciplinary actions in other states that we would have never found had it not been for provider trust. So we’re able to give the, you know, the CNO or the administration or HR administration an opportunity to say, okay. I’m not sure you found this in the background check or if you even check for things like this, but wanted you to be aware that, you know, in the past, these things were on their record. They can choose to keep them or not because they have active license in the state of Alabama, but it it has brought to light some things that we have with other clinicians that might be a reason why we have them that we would never have found had it not been for provider trust and their ability to find these things in other state. That’s awesome. Thanks for sharing that. As you were talking about that, you alluded to, you know, chief nursing officer and kind of HR and operational decisions. Right? In compliance, we we we can share the information, but we ultimately often don’t have the final say. Right? It’s it’s operations or or clinical work, right, that has that opportunity. So I know when we chatted before, you had talked about really the kind of eye opening experience and some of the opportunities that you had during implementation to really reach out and integrate into your your EMR and into your HR system. Maybe just talk a little bit how important, really kind of the implementation process really, I think, opened up an a a better dialogue and a better opportunity for you to to be partnering with other teams and then ultimately getting you all the data that you needed so that you could monitor all those populations. So maybe just talk a little bit about that process and and maybe some of the the challenges and the the opportunities, that came from that. Okay. Yes. The implementation, I, I had a contact on the university side from when I worked at the university in internal audit, that was in IT that handled our banner, which is our financial software and our payroll software, and it’s kind of the the source of truth for our, or we thought it was until ProviderTrust implemented it with, their system. So, there was a lot of holes. So I’ve I I contacted someone in HR that’s kind of an HR IT administrator and then the IT administrator from campus for Banner. And then we have a credentialing, manager, and I, she has her own software that she was very, secure with, but she did provide us with a a feed, that Marlo, helped us with. There were a lot of things that were eye opening as far as, HR and the banner process didn’t have licenses listed, or if they had them listed, they had them listed incorrectly. Like, they’d have, that it was a Alabama state and it was a multistate, which which kind of y’all can’t check them as well if our, you know, garbage in, garbage out kind of data. So Marla was able to help us get implementation streamlined where everything was in the right columns. And now HR, has when they onboard people, they actually put them in the right, spot or blank in banner so that they feed to provider trust correctly. I had some, I guess, hesitations with some of the information that provider was trust was providing us, about some of the people that we had hired, which, you know, I’m not HR. I’m not the hiring person. I’m not the administrator. So, I talked through with her on those issues on a sidebar before we had our weekly meetings, and she was able to bring up incidents where other facilities have, encountered these types of, I guess, probationary items or things like that, and she was able to bring it to how they other facilities handle it. So it wasn’t me calling out HR or me, addressing it. It was a vendor that it has encountered these things with other universities or other health care facilities and how they handle it. So it gave us a little background into how we should handle it. A little bit of credibility. We we talk about best best practices. Right? And that’s one of the things that we are really proud of at ProviderTrust. Right? We have, the opportunity to to sit sit with our clients and, you know, my my former role was the chief compliance officer of a health system. So being able to sit in your shoes and be able to talk about what we’ve seen across all sorts of different health systems, I think, is really valuable in being able to give you all peace of mind, a little bit of ease. And sometimes, like you said, bridge the gap between compliance and HR and other teams so that you don’t feel in compliance like you’re always the bad guy, that you’re always the one that has to share, not always the best news. So glad to hear that that that was an opportunity. And implementation was very I I think it happened rapid, pretty rapid or, faster than I had expected, and I think everyone else had expected too. It was, we did have the right people on the calls, and the fallout from that was that people under them had to start doing better, and entering the data better. So it it it was very cohesive and, easy and, professional. Marlo handled every administrator, professional diplomatically. And, you know, any of my concerns, I addressed offline. And she was able to, find a best practice that she shared with the group. And it it really did go well. And everybody was happy with it, and we are finding, things that we would not have known whether we went with, me doing it manually or some other provider because most of the, vendors that I looked at, couldn’t offer the the total package, the credentialing, the, checks, the license checks, the forty three states of Medicaid, OIG, and the Samsung. So it it it really worked good. I’m so glad to hear that. And and you kind of alluded to some kind of data cleanup. Right? So one thing we do find often in our implementations is that, like you said, garbage in, garbage out. Right? Good data, bad data. And and so we think about, as a compliance professional, the risks that we take on when we’re we think we’re monitoring the right people. But then when we look at our data and we don’t have the the most current name or we have a license number that was just, you know, fat fingered when it was entered. And so you weren’t necessarily looking at, like you said, a compact license as opposed to a multistate license versus just a single state license. And and one of the things usually during our implementation, it is a little noisy maybe, right, for the compliance professional managing the dashboard with some alerts that were saying, hey. This name is isn’t quite right or this license number isn’t quite right. But, ultimately, it sounds like you had the opportunity to really kinda navigate through that, get your data in a state of accuracy so that we all know that we’re monitoring the right folks. And then if someone did have, you know, an action in the past, we’re able to share that with you or, like you said, identify a probationary license or a sanctioned license that you might not make a a a decision to to separate with that person, but better to be aware, right, that there might be a restriction on their license. So, go ahead. Sorry. I I want I actually wanted to share with y’all, right out of the gate. I I think it was the first month after implementation. There was a clinician that I had already checked. HR had asked me to check upon, you know, background check, and I checked in OIG, and she wasn’t sanctioned. But her name had been changed three or four times, so I had went back to HR. And I said, as far as the name, I cannot, you know, identify this person as being sanctioned anywhere. Y’all found that she had been sanctioned because y’all were able to pull it from the Social Security number, and I had data. And they said, well, we had Cynthia check it, and she said they weren’t sanctioned. But I also had emails back and forth to HR where they wouldn’t provide the Social Security number because they didn’t want to. They thought that I didn’t have a need for that, and there’s no way to drill down when, someone has had multiple marriages or multiple names, who that individual actually is with when you’re checking it manually on the OIG website. So, we were we allowed that person to resign, but that would have never came to light had, we not implemented it with provider trust because they had checked by social, which we don’t have access to in banner. They won’t provide it when we’re checking, so we check the best way we can, which is is obviously not very well. So, that was quite an eye opener. And in the implementation, Marlo, worked with our IT at Banner, and they configured several other spots and ways to put, multistate, Alabama state and other licenses so that it would feed over and that HR would be able to input it correctly and that it flowed to Banner, then it flowed to provider trust moving forward. I think that took maybe six weeks, two months to get us on board with that, but it was due to Marlow helping the IT streamline those categories and and and how to put them in. I do think it’s a lot about process. Right, Donna? Oh, yes. In that process and making it making a little bit more tenable for the long term. Like, whether it was had a character in front of it, on our side and not y’all side or the OIG side. So they were able to, put all three in one one bucket so that it would be easily downloaded every week, and y’all could check it. That’s fantastic. We were checking it once a month, and it still took three days, and it wasn’t efficient Yeah. Or accurate. That’s a really great call out. I think that’s one of the benefits, right, of you can upload upload your data, right, as frequency as frequently as you wish. And once it’s in our system, you know, our system kinda just takes over. Right? And if the data is, we tell you. If your data changes, we tell you. And you’re not just kinda doing that once a month, check the box. I looked at every name, and I think they’re good, and I move on. And and I think, I think And it the dashboard is is is fabulous because it it has red alerts, yellow alerts, and we’re able to Marlo actually configured messages, for us specifically. Like, once compliance reviewed it and it only needed to go to HR, we have a a drop down menu that says HR needs to review. So when HR goes to the board, it’ll still be a yellow work, but they know that they’re supposed to. They can just filter on the dashboard by HR needs review so that they, you know, omit the seven thousand other they’re all there, and they’re there if we need to know on it, but we don’t have to filter through those weekly or daily or monthly or anything. Everything is exactly how we set it up on the dashboard. It can be configured to how you want the messages. Yeah. So that was a very help because we have our hands in it and then HRS because they don’t want us having access to the Social Security numbers and things like that. So the day the data is uploaded from our banner, and we we clear the like, nurses. Like, they might have the wrong license or expiration date in banner. So y’all alert us to that. We found the name, but this is not the license number. So that message comes up as an alert on the dashboard. Compliance goes out to the, nursing board online, gets their license, attaches it. You’re able to attach it in the in the dashboard in ProviderTrust so that HR doesn’t have to go look for it. We’ve done the work for them. The license is there. All they need to do is change it in banner. So next week when the feed comes through, it comes through correctly and clear and they clear up and resolve the the alert. So it’s it’s really nice. That’s awesome. And I know our system will then take it from there. Right? It’ll update expiration date. It’ll give you new screenshots every time that we check. So that’s great. So we only have a minute or two left. We’ve had such a good conversation. We just always get lost in our our conversation. So, maybe just as we close, we we certainly won’t have time for q and a. But as as we close, I guess, Cynthia, like, if you’re sitting, talking to someone in your role at a different academic health system, like, what would you be telling them about, you know obviously, you’ve talked about it saved you, you know, three days of work. You’ve talked about the accuracy of data. But any closing thoughts that that you would wanna share with, you know, why provider trust or more importantly, how this has given you free time or never? Compliance officers do not have free time. But more time to focus on, other things within your organization or just kinda closing thoughts on, kind of the risk reduction and and how you’re feeling today and just words of wisdom. It’s it’s it’s actually alleviated a a lot of manual work, a lot of, we feel more confident that if we’re ever audited, that the information is all in one one location. I don’t have it. HR doesn’t have it. We’re able to pull it, OIG or, whomever may be auditing you. They don’t give you a lot of time to find the data, so we don’t know we no longer have to worry about what share drive it’s in, who has access to it. We can HR could pull it. I could pull it, or the university could pull it. It’s all in one location, so that that’s very helpful. I would give them, I would say make sure before you decide to, implement, make sure you have really good HR and an IT from where your source to help, and it made it a lot faster because Marlo can speak the IT, and, she’ll get the best practices for the HR elements of it. So just make sure you have really good people on that implementation team. Don’t use a lot of people. Just get two or three key people that you can trust and, you know will do the work. And that that really streamlines it for both parties. I think I think give yourself some credit, Cynthia. I think a lot of the reason that these, these projects go well is because we have a a strong project manager and project leader by inside. So Well, thank you. Certainly. Well, listen. I think we’re we’re at time. I wanted to say thank you again, Cynthia, for taking the time. And, Donna, thank you so much as well for, sharing a half hour of your your your day with us. For the folks that attended, thank you so much. I hope this was helpful. And, again, we’ll go ahead and, we’ll send this out in a follow-up email along with a quick case study and a recording of, of today’s session. And if you’ve got any, questions or comments or, emotional outbursts, certainly don’t, don’t hesitate to reach out to us. We’re certainly here to help. So thank you very much. If anyone has questions, I’ll be happy to answer them if they wanna, facilitate them through provider trust or email me directly. It’s it’s it’s been very, very helpful, and I can, provide any type of help that they need. Thank you, Cynthia. That’s awesome. Mhmm. Appreciate that. Alright. Have a great day, everyone. Thank you. Take care. Bye bye.