In Las Vegas last week, surrounded by thousands of healthcare compliance professionals in Caesars Palace, I couldn't help but call to mind that famous bass line from the 1981 song “Under Pressure” (The original version by Queen and David Bowie, that is, not the sample.)
Stress was a top-of-mind topic throughout the 16th annual Health Care Compliance Association's Compliance Institute, thanks to a survey the group conducted of its members this year that came back with a couple of startling conclusions.
HHS Inspector General Daniel Levinson said in his opening address in a huge Caesars banquet hall on April 30 that he was taken aback by the survey's finding that as many as 60% of compliance officers have thought about quitting their jobs because of the stress they face in the workplace. And 58% reported waking up in the middle of the night from stress.
Levinson suggested that compliance officers try to read at home some of the OIG's detailed advisory opinions to healthcare providers on avoiding legal problems, because getting concrete information can be a stress-reducer. “In fact, if you have trouble sleeping, take some home,” he said in a moment of levity, generating chuckles around the room.
The next day, Marjorie Doyle, a Meade and Roach attorney and managing director of Aegis Compliance and Ethics Center, had the crowd in the same cavernous space reaching for the chandeliers and shouting “Help!” over their stress levels. “Clearly, the bottom line is, the profession is under stress,” she announced to the group.
Why all the stress? In various interviews, I've heard how compliance departments become places where problems get dumped that no one else wants to deal with. Then the compliance officers have to decide whether to challenge other healthcare executives to take on the problems, and face possible sanctions, or to find some other means of resolving them, all while trying to interpret punitive, evolving and sometimes vague rules from regulators.
“I think being the messenger can be really challenging and difficult,” Shawn DeGroot, vice president of corporate responsibility at Regional Health and the new president of HCCA, said during a general session panel discussion titled, “Stress, Sanity and Sensibility.”
She recalled a story in which she reported the “good news” that the hospital compliance department had discovered a 100% error rate in a certain billing area and had taken action. A hospital official in the room was not as happy about the news.
“He said, ‘Pardon me? How is that good news?' I said, ‘Because we found it, and not the government,'” DeGroot recalled.
Panelist Daniel Roach, vice president of compliance and audit and Dignity Health, formerly known as Catholic Healthcare West, said he relies on his staff to do a good job and relieve him of stress, such as the person in his office whose job it is to review the Federal Register regularly to look for new rules. (And there's a job you'd love to have, right?)
“Clearly, keeping up with laws and regulations is a challenge,” Roach said. “If you really want to keep your stress down, hire people who are smarter than you, and listen to them.”
Robert Ossoff, assistant vice chancellor of compliance and corporate integrity at Vanderbilt Medical Center, told the panel crowd that compliance officers have a responsibility to deal with their stress, perhaps by finding time for exercise or other personal pursuits.
“Knowing that this job is stressful, we all have a responsibility to ourselves to deal with it,” he said. “You get paid for that.”
Compliance officers' stress, however, was not by a long shot the only topic of conversation at the conference.
A capacity crowd in one of the huge ballrooms listened to a lecture from Aaron Beam, former chief financial officer of HealthSouth, as he described the infamous compliance situation at his former employer.
Beam told the crowd about how impressed he was following his first encounters with the former HealthSouth CEO Richard Scrushy, who today is known by some people
as federal Bureau of Prisons inmate 24463-001.
Scrushy was acquitted by a jury in 2005 of charges that he coerced healthcare executives into committing fraud, but was subsequently convicted in a new trial for attempting to bribe Alabama Gov. Don Siegelman for a seat on the state's Certificates of Need Review Board.
In his Las Vegas talk, Beam recounted how he described one of his earliest meetings with Scrushy: “I told her that I had met either the most brilliant businessman I would ever meet, or the greatest con-man I would ever meet.”
Over lunch that same day, compliance officers were treated to a talk by Ketanji Brown Jackson, vice chairwoman and commissioner of the U.S. Sentencing Commission, who noted that organizations don't always have to “know” about criminal activity by their employees in order to be liable for it under federal sentencing laws for organizations.
Jackson also highlighted a new rule contained in the sprawling healthcare reform law, Section 6401(a)(1)
, which mandates that any provider who participates in Medicare must now have or establish a compliance program.
In another panel, David Hoffman and Associates President David Hoffman addressed one of the burning topics in healthcare compliance: CMS audit contractors' recent intense scrutiny of short inpatient stays.
Hoffman said the rules on when such stays ought to be properly classified as inpatient or outpatient stays can be open to interpretation, despite the audit contractors' strict enforcement: “Contractors are going crazy, and it is not clear. And there needs to be some pushback here,” he said. “These rules are not clear.”Modern Healthcare reporter Joe Carlson covers legal affairs, including healthcare reform, fraud and compliance, labor, and regulatory news.