The misuse of physician recruitment data has become big business for the Department of Justice. Since January 2009, the DOJ has recovered a total of more than $25 billion through False Claims Act cases, with more than $16 billion of that amount recovered in cases involving fraud against federal healthcare programs. In the face of this increasing enforcement activity, thoughtful understanding and appropriate implementation of referral and recruitment data is more important than ever.
Physician referral data, defined as information regarding where employed and independent physicians refer their patients, is a key tool for hospitals and healthcare systems looking to expand services to better suit their community. While physician recruitment and referral data collection is an accepted and familiar practice, physician recruiters and liaisons must be careful as they go about their business of encouraging physicians to send leads their way. Any hint of negative financial or employment repercussions towards physicians comes with big consequences.
This past Fall, a series of settlements reinforced the seriousness of this matter. In August, two southwest Missouri healthcare providers agreed to pay $5.5 million to settle allegations of improper financial relationships with referring physicians. In September, Adventist Health System agreed to a settlement of $118.7 million for allegations that it offered doctors excessive compensation for referrals. And in October, the DOJ resolved a $237 million judgment against Tuomey Healthcare System for illegally billing the Medicare program for services referred by physicians with whom the hospital had improper financial relationships.
Statutes put into place by the Affordable Care Act and the increasing availability of referral data in electronic formats, have government watch agencies cracking down like never before. Healthcare professionals and physician relations experts must stay on high alert, being extra careful that they are performing their jobs in full compliance with the complex laws, rules and regulations regarding physician recruitment data.
With the urgency of the matter clearly present, here are suggestions to mitigate the risk of coming under the scrutiny of the DOJ.
- Be sure to thoroughly educate your physician relations team on best practices and make sure they have a clear understanding of the law. While the rules regarding use of recruitment and referral data are intricate and could be considered confusing, ignorance will not be a passable excuse for misuse.
- Use a physician tool that will minimize risk. In all of these cases, the DOJ will scrutinize a hospital’s internal process to determine where referral data originated. Stay ahead of your process and be sure your physician relations team is using a system that clearly does not intimidate physicians.
- Watch carefully that you are keeping a healthy separation between your physician relations and operations/business development teams. This separation will protect from discussions and actions that could be viewed as suspicious activity by the DOJ.
Based on these recent developments, and in keeping with DOJ activities, the Stratasan team took proactive steps when developing the Physician Pathway platform. To ensure that use of our tool would keep your team in check with regulations, the following adjustments were made:
- We do not showcase any charts that could infer priority for certain doctors, based on their activity.
- All language used is objective to protect against negative interpretation. For example, instead of listing physician referrals as an opportunity or non-opportunity, the terminology used is lost and captured.
- Colors used are non-aggressive.
- Maps are clear of any high/med/low potential index.
- Physician recruitment data is masked for low case count, meeting HIPPA compliance.
The Physician Pathway platform does not infer which physicians should be prioritized nor directs recruiters to conclusions on how to make decisions. Instead, the tool provides information that recruiters, physician liaisons, and business development professionals can use in order to have more informed conversations with their physicians, thereby building and strengthening those relationships. Reports can be trusted and used by physician liaisons with confidence because the numbers presented are real in that they are based on actual numbers, not modeled data. Because of this, they tell an accurate story that does not present a problem when reviewed by the physician. Physician Pathway presents real data with no “black box” models. By not modeling data and instead, presenting reality, you can improve your relationship management by knowing and discussing concrete facts.
If your hospital system is in the business of physician recruitment, be sure to carefully consider the tools and practices you are using to track leads and referrals. If your team is not actively using a physician referral tool, consider how it might be the right addition to your growth strategy. Contact Stratasan to learn more about the Physician Pathway platform and arrange for a free strategy session with our product specialist.
Article by Tony Camarata, Product Manager for Stratasan.