The value of preparation

Editor's note: At a time of rapid change in the healthcare industry, HHS Inspector General Daniel Levinson's office is charged with steering healthcare companies on the path of honest and transparent work. Modern Healthcare reporter Joe Carlson sat down with Levinson last week to talk about new developments in that mission. The inspector general had just finished delivering his April 22 keynote address to the Health Care Compliance Association's annual Compliance Institute, held this year in National Harbor, Md. Levinson discussed plans to continue auditing hospitals and expanding those types of reviews to Medicare Part B expenses. He also touched on efforts to persuade healthcare companies to turn themselves in when they uncover wrongdoing internally, and the fraud implications of the rapidly growing use of EHRs. Here is an edited excerpt:

Joe Carlson: You mentioned the recent bombings in Boston during your speech. Do people in healthcare compliance have a role in terms of disaster preparedness?

Daniel Levinson: I think that compliance has a role throughout the healthcare world and, yes, I can't imagine a corner that they wouldn't be involved. But what I think was impressive about what happened in Boston is how responsive everyone in the healthcare community was and how effective, how capable, how on top of that emergency people were.

Carlson: But is there a compliance function in making sure that a hospital actually has a plan, a written plan?

Levinson: Yes. We had found based on our work post Katrina how important it was for healthcare institutions to be prepared. Part of that preparation has to be meeting the requirements that are set for facilities. And based in many respects on our post-Katrina audit work, we issued a series of reports indicating that there were vulnerabilities; there were weaknesses that needed to be corrected. An important part of compliance is thinking not just about the day-to-day requirements and activities, but realizing that many of these requirements have to do with the ability to be responsive when it comes to emergencies.

Carlson: You mentioned the ongoing hospital compliance audits that the inspector general's office is doing, and I think you said 25 are planned for this coming year. Do the 25 hospitals know who they are?

Levinson: We don't necessarily broadcast a menu of that, and I think that there is certainly an effort to provide the kind of notice that will make these reviews most productive. And this has been a very helpful initiative and is probably the kind of systemic review that would benefit from potential applications in the world of Part B.

Carlson: Is that something new that would be added to these audits, or would this be a new set of providers?

Levinson: We just don't have the kind of structure in place that has permitted our auditors to look at multiple billing or coding issues in one visit. We need to think through a strategy that would take advantage of developments in technology that would allow us to look at the smaller providers, which one-on-one don't really provide the economic impact that larger institutions do. Part B is huge, and we need to do as good a job as possible of covering in a more comprehensive way the universe of Part B services.

Carlson: There's been a lot of press in the past year about this phenomenon of electronic health records being tied to an increase in healthcare billings, and if you listen to the critics, they say that EHRs are being used for nefarious purposes. What is your take on that debate?

Levinson: When I first came on board a number of years ago, the office was just getting involved with the department on framing the original electronic health records “safe harbor” (for hospitals to subsidize EHRs for independent physicians). I sensed that it was important to create an environment in which there would be the donation of this kind of equipment without running afoul of the kickback statute. And at that time, there was a lot of uncertainty as to how this would unfold, but there was considerable confidence that indeed this is where we were going and we needed to create a clearer path.

That's 2005, 2006, a number of years ago; and here we are in 2013 having to address what we do as we head toward sunset toward the end of the year. And it was interesting to get such a wide variety, so far, of comments from people and institutions about how they saw this headed and what we may or may not do. And it just reminds me that this is very much an evolving landscape and that there is no pure or obvious solution to being able to move ahead with electronic health records without coming into play this balance of how you make it most effective, keeping in mind that there are plenty of landmines along the way—that you need to appreciate the vulnerabilities, the way that computer technology allows the amplification of human error and human malice as much as it does human intelligence and human capacity.

Carlson: Someone pointed out to me the new provider self-disclosure protocol actually explicitly says in its terms that it's now open to non-providers to make disclosures. The person wondered why it was still called the provider protocol.

Levinson: I will let people interpret however they want both the naming and the substance of the self-disclosure protocol, but I do think that it represents a very, very important step toward making it as user-friendly as possible, because self-policing is such a critical part of making compliance work. We are not an especially large office given the portfolio, the jurisdiction that we have; and one reason why I appreciate the opportunity to speak with compliance professionals here at HCCA every year is to, again, reinforce the notion that we need to be effective partners. So, the most effective thing a partner can do when it comes to our work is to take on the role to a certain degree of the internal inspector general for their institutions and help us make sure that we are on the same page.

Follow Joe Carlson on Twitter: @MHJCarlson