Eight rules for physicians in compliance programs
Eight rules for physicians in compliance programs
As hospitals work to implement the Department of Health and Human Services’ Office of Inspector General (OIG) final compliance plan for individual and small group practices, Mark Pfeifer, vice dean for clinical affairs at the University of Louisville, says hospitals should anticipate considerable resistance on the part of physicians.
After several years of uncertainty, Pfeifer says the rules and expectations are now more evident. But there is still the challenge of changing physician behavior. "There is a real danger in this area if you are responsible for dealing with physicians, and we should not ignore that," he cautions.
According to Pfeifer, that danger stems from a difference in the perspectives regarding the OIG’s physician guidance. On its face, the plan may amount to a formal set of policies, procedures, and regulations to prevent, discover, and correct fraudulent billing. But Pfeifer cautions that some physicians take a far more sinister view. To combat that impression and improve physician compliance, Pfeifer suggests that hospitals consider the following steps:
s Leave the pulpit at home. Pfeifer warns that teaching physicians compliance can get "very preachy very quickly," and instructing doctors to "do the right thing" is not enough. To be effective, he says, hospitals must appeal to physician’s self-interest. At 6 p.m., when medical staff are sitting in a nurse’s station documenting a Medicare encounter, messages that address the fate of the Medicare trust fund are likely to carry little weight.
s Use data, not dictum. Hospitals must learn how to use data to convince physicians about the values of compliance. Pfeifer says power comes from using data fragments to alter perceptions and generate appropriate responses.
Most physicians respond well to data, he argues, especially when it is may reduce their own risks, lead to value-added services, or save them money.
s Promote enlightened self-interest. In one sense, Pfeifer says "enlightened self-interest" is simply a nice name for selfishness. But he argues that the key to success is convincing doctors that the program as well as the consequences are theirs and not anybody else’s.
s When dealing with physicians, be a hospice worker and not a surgeon. Physicians will progress through compliance education at different stages and at different speeds, warns Pfeifer. "I suggest that we try to meet them where they are in those stages and try to teach them at that level," he says. "I see our role as helping physicians get through this and not trying to fix it."
s Park it in neutral. "[Physicians] will vote you off the island if you in fact sound too excited about all of this." He also warns against trying to be popular with physicians by trivializing the issue or joining "the fraternity of cynicism" that can develop. "Stay neutral," he urges. "That has been the secret of success in our institution."
s "Don’t just do something, stand there." Pfeifer says hospitals should be slow to respond to the "inevitable absurd responses" from some physicians about certain facets of the compliance program. "You will hear longings for yesteryear," he says. But if hospitals become defensive about their compliance programs, it will be difficult to develop a culture of "organizational self-education," he warns.
s "Spot your 800-pound gorillas early. You do live in a world with high-powered players," says Pfeifer. "Spot them early and identify them." He says that means leaders in this area must be respected and have tenure. However, you should also seek to involve other physicians, ideally of the same specialty. "Some opponents we defeat, but there are others we work around, and some we simply try to outlive," he explains.
s They have got to eat sometime. Pfeifer says hospitals should not overlook practical steps either. Physicians spend most of their time speaking and giving opinions, he notes. "If you finish a meeting with physicians about compliance and they have not had a chance to speak, I would suggest that your meeting is a failure," he says.
Finally, Pfeifer says hospitals should use these suggestions to improve communications with doctors: 1) prepare to listen; 2) defer impossible one-on-ones; 3) run short, organized meetings; 4) keep it pragmatic; 5) use multiple small hints; 6) use humor and avoid sarcasm; and 7) schedule training during lunch or existing meetings.
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