A Tale of Training ~In the 21st Century~

A Tale of Training
~In the 21st Century~
HCCA Managed Care Compliance Conference
February 23, 2010
Kelly Wittmeyer & Sally Gibbs
Sutter Health Ethics & Compliance Services
Objectives
• After attending this session attendees
will learn:
– How to sustain a positive approach to
education planning
– From the mistakes of others to help avoid
your own pitfalls
– How marketing and communication plays
an important role in education
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About
Sutter Health
• Sutter Health is a network of physicians, hospitals
and other healthcare providers throughout Northern
California.
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25 Hospitals
3,500 Physicians (1,800 in medical foundations)
44,892 Employees
17 Ambulatory Surgery Centers
8 Cardiac Centers
10 Cancer Centers
5 Acute Rehabilitation
9 Behavioral Health Centers
259,873 Home Health Visits
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A Solid Foundation
• Education and Training is one of the 7
elements of an effective Compliance Program
• To be effective you need a solid plan and
platform
– Identify system needs through your data
• Audits
• Risk Assessment
– Identify risk to your organization
• Evaluate reimbursement impact of each area
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A Solid Foundation
– How we developed our plan
• Who are the key players in the risk?
– Physicians or billers (both?)
• How do we address the problem?
– Different audiences require different education
strategies
• Part of the annual work plan with objective
measures
• Reviewed by Internal Audit and Subject Matter
Experts
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Leading by Influence,
Not Authority
• Obtaining buy-in is critical to success
– From the top down
• Top management must believe in the project
– How to get buy-in?
• Building positive relationships with key players
• Be ready to demonstrate the value
• Ask for their participation
• Obtaining influence
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“What’s In It For Me?”
• Obtain Continuing Education Units for any
person who might take the course
– HIM professionals, physicians, nurses, billers,
physical therapists, etc
– Which organizations do they belong to?
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American Academy of Professional Coders (AAPC)
American Academy of Family Physicians (AAFP)
American Health Information Management (AHIMA)
California Association of Physical Therapy (CAPT)
California Board of Registered Nursing (BRN)
• CEs required prior planning
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“What’s In It For Me?”
• Stay organized
– Different application requirements
– Different costs
– CE begin date and expiration date
• Benefits – no cost to students; easy
access to CE
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“What’s In It For Me?”
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Physicians – American Academy of Family Physicians:
Category 1 CME
– Compliance training provided by Sutter Health to physicians and
their office staff is permitted under an exception to the Stark law’s
ban on remuneration to referring physicians. Although compliance
training could be considered a type of remuneration, it is excepted,
as a matter of public policy, to promote legal
compliance. “Compliance training” means training on the basic
elements of a compliance program or specific training on federal
healthcare program requirements, such as billing, coding,
reasonable and necessary services, documentation, or compliance
with the Stark and Anti-Kickback laws. Compliance training
includes programs that offer CME, as long as the primary purpose
is compliance-related.
• (See 42 CFR 411.357(o))
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Effective
Communication
• Keys to effective communication
– What to do • Talk to Everybody – Dept managers, educators, any key
player
• Try to be flexible where possible
• Be receptive and gracious to criticism
– What NOT to do
• Work in a silo
• Be an education dictator (you attract more bees with
honey than with vinegar)
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Rules of Effective
Communication
1. Simplicity. Use small words. The most effective language clarifies rather than obscures.
2. Brevity. Use short sentences. Never use a sentence when a phrase will do.
3. Credibility. Credibility is as important as philosophy. Remember that people have to
believe it to buy it. Your words must be sincere.
4. Consistency matters. Repetition, repetition, repetition. Brand your product. and stay in the
public eye.
5. Novelty. Offer something new. Tell customers something that gives them a brand new take
on an old idea. A message that combines surprise and intrigue works best.
6. Sound and texture matter. The sounds and texture of language should be just as
memorable as the words themselves. A string of words that have the same first letter, the
same sound, or the same syllabic cadence is more memorable than a random collection of
sounds.
7. Speak aspirationaly. Personalize and humanize the message. If the listener can apply the
language to a general situation or human condition, that is humanization. If the listener can
relate that language to his or her own life experiences that is personalization.
8. Visualize. A slogan or message should have strong visual component, something to see
and almost feel. “Imagine” is one of the most powerful words.
9. Ask a question. This can be rhetorical or not. Questions are interactive! “Imagine yourself
in this situation. What would you do?” Did you notice we followed rule number 8? We also
used 1, 2 and 6 in the question. The answer to this question follows rule 7.
10. Provide context and explain relevance. You have to give people the “why” of the
message before you tell them the “therefore” and the “so that”.
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Based on the book “Words That Work” by Dr. Frank Luntz
Mistakes That
Plague
Mistakes that often plague the best training programs:
• Lack of communication
– Thinking you communicated to the right people. Talk to
everyone!
• Lack of clarity
– Talk to people and make sure your communication documents
are clear.
• Assuming your training is perfect
– Have a few people take a test run and work out the bugs.
• Unwillingness to improve your product
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– Read students evaluations.
– Update materials as rules, laws or policies change.
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Marketing
• The importance of marketing to
energize your program
– Branding
• Through a color scheme/artwork
• Develop a key message
– “Just Do It” “Thrive” “With You. For Life.”
– It’s okay to take the credit!
• Recognition for your hard work
– Communication tie-in
• Get the message out!
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Staying Current
• How to keep your training fresh, current
and appealing
– Make a commitment
– Monitor evaluation results
– Review and update content annually
– Be willing to let go of the past
– Keep an open mind
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E-Learning
• Sutter Health Ethics & Compliance uses
Articulate® software
– Easy to use, interesting features
• No software is perfect!
• Can use sound or not.
– Compatible with our IS standards – had to
get permission
– See our journal of trials and tribulations
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E-Learning
Articulate: author
&
publish
HealthStream
E-Learning Platform,
Learning
Management
System (LMS)
Burn to a CD
Play off a website
Burn into Word
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E-Learning
• Some paranoia is good!
– Backup. Backup. Backup.
– Save to hard-drive.
– Save to jump-drive.
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E-Learning
• ADA compatibility
– Difficulty hearing:
• E-learning courses with sound are available in
a book format and the speaker notes are
available in Articulate® in the notes section.
– Vision Impairment:
• Courses with or without sound can be provided
in the PowerPoint version or the book format to
adjust font size.
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Monitoring
• Education completion rate should be
incorporated into your compliance
dashboard.
• Senior leadership enjoys the
competition.
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The Education
Fix?
• Education fixes everything, right?
• Education is just one piece of fixing an
identified problem.
• Realize that there are many barriers to
change.
– How can you partner with others to help bridge the
gap?
• E-learning is one solution. We still provide
seminars and audio-conferences for
appropriate topics.
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Factors Effecting
Behavior
• Why people won’t or don’t change
behavior
– Fear of loss of autonomy
• “I know what I’m doing, I’m not changing anything.”
– Lack of internal accountability
• “Nothing will happen if I don’t change…”
– Lack of resources to implement/support
changes that need to be made
• “I need help to make this happen.”
– Fear of failure
• “If I can’t do it right I’m not going to try at all!”
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Factors Effecting
Behavior
• Solutions – Change Behavior Through
Influence
– Leadership needs to be accountable for
internal outcomes.
– Leadership needs to create a culture of
change.
– Affiliates should make allowances for
resources that will not impact patient care.
– Leadership should cultivate a culture of nonretribution.
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Momentum
• Keep the momentum going
– Keep open lines of communication
• Never shut anyone out, even if you get
frustrated
– Compliance Dashboard
• Tip - Be prepared for road blocks from
people who previously agreed to help
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Outcomes
• To date we have trained 16,184 people through
e-learning in the following courses:
– Emergency Department CPT Coding
– Outpatient Physical Therapy Documentation & Billing Practices
2009
– Nursing Documentation for Hospital Outpatient Infusion &
Chemotherapy
– Infusion Therapy I: Hospital Outpatient CPT Coding
– Infusion Therapy II: Hospital Outpatient CPT 2009
– 2009-2010 Annual Compliance
– Outpatient Laboratory: Documentation & Billing Compliance
– Diagnostic Imaging: Regulatory & Billing Compliance: NonHospital
– Physician Dermatology Documentation & Patient Care
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Outcomes
• Positive comments
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“It was great! Good Job!”
“Awesome!”
“This training was helpful and a great reminder.”
“I finally understand Initial Service Code”
“Kudos on the job well done with this
module! Absolutely fantastic!”
– “This new look is long overdue and is the direction
we should be headed in.”
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Questions
•
Kelly Wittmeyer [email protected]
•
Sally Gibbs [email protected]
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