Is the Integrity Gap Widening in Behavioral Health?

It wasn’t too long ago that Behavioral Health received little attention with respect to integrity of our industry. However, with increased attention of the Department of Health and Human Services (DHS) and the Office of Inspector General (OIG), Behavioral Healthcare leaders, like other healthcare leaders, must re-examine their internal operations and practices to protect their organizations from fraud and abuse.

With Behavioral Healthcare billing millions and millions of dollars to Medicaid, Medicare and other healthcare programs each year, the growing attention received from the Federal Government is not likely to go away. Has fraud and abuse increased in the Behavioral Health Industry? We hear more and more about incidents occurring across the country including inaccurate claims, billing fraud and a range of unethical practices. Is the “Integrity Gap” widening in Behavioral Health?

The “Integrity Gap” refers to the “distance” between our day-to-day conduct and the ethical standards of the organization. If an organization operates unethically, the organization moves further away from its ethical code and widens the “Integrity Gap”.

To protect the integrity of the organization, the leader must be committed to establishing an internal compliance program to prevent fraud, abuse and other unethical practices. As leaders, we must insure a culture of integrity and manage the “Integrity Gap” within our organization.

To do so, we should develop compliance programs with internal controls to manage these risks. Effective compliance programs will consist of: 1) Statement of Conduct (organizational ethics), 2) Compliance Officer, 3) Compliance Hotline (insures anonymity of whistleblowers), and a process for 4) Internal Investigation.

Several high risk areas for abuse and fraud include inaccurate billing/claims, contractual relationships (internal/external), over-billing Medicare/Medicaid (In the past, it’s been reported that some financially struggling providers have used this technique to “float loans” to the organization until external audits require paybacks which in many cases don’t occur for several years).

Needless to say, internal controls with respect to inaccurate billing are essential in your compliance program as this is the area that receives the primary attention from external regulators. However other areas critical to the integrity of your organization should not be overlooked nor viewed as less important. Contractual relationships, Conflict of Interest, vendor/referral relationships, fundraising and so on – if mismanaged can seriously impact the integrity of your organization, widen the “integrity gap” and impact your ability to service your community.

Brown Consulting, Ltd provides Toll-free “Employee Action Line” to support your in-house Corporate Compliance Program. For additional information, call 800-495-6786.

Dan Brown, President

For more than 30 years, Brown Consulting has helped behavioral health organizations improve their operational foundations—from strategy, to policy, to accreditation, and more—in order to provide their patients with superior care.

Excellence is a journey, not a destination. Brown Consulting is here to help our clients in that journey, and we also are seeking ways to improve our own services. With that goal in mind, we are pleased to announce the launch of our new website.

When you visit danbrownconsulting.com you will find it easier than ever to access the specific service in which you are interested, such as:

• strategic planning
• operational consulting
• regulatory compliance
• turnkey program development

There are quick and easy online forms where users can immediately request resources, a personal contact, or to schedule a free consultation. Additionally, the new design has been optimized for better viewing and navigation on mobile devices such as smart phones and tablets.

There is also a new “Who We Work With” page with information about some of the respected and satisfied clients that we have been privileged to serve. The news page will provide the latest on our services, and the ever-changing behavioral health landscape.

Our mission is to provide clients with results, not promises. Our improved website is a direct result of our commitment to superior customer service.

Effective Leadership

In a lot of discussions today, many administrators, leadership groups, management teams and even consultants talk about the most critical aspects of organizations today. Is it Human Resources, QI Culture or MIS capabilities? I believe all these aspects are important – even critical – but the most critical are the organization’s leaders. Who are its leaders and how effective are these leaders?

When I define what an effective leader is, do we look at the bottom line (profit/loss)? Longevity? Proficiencies, etc.? While it is obvious that each is important, having the opportunity to consult with nearly 300 organizations, I’ve learned that every leader is unique in style, personality and focus. Therefore, I believe the only true measure of effective leadership is how effective the organization is. If the organization is not functioning well, it has to go back to its leaders – not only the CEO, but all its leaders. Administrative Leadership Group strategies and even senior staff. Anyone who influences others is a leader within your organization.

Today I am seeing more and more executive leadership groups struggling with their organization, certainly in our economy. Where our organizations are at in the Business Development Cycle and on supportive staff impart our ability to lead. Let’s look at effective leadership – what are they made up of.

How do today’s leaders develop and maintain organizations that are motivated, creative, innovative, legal and committed?

Effective leaders are the following:

Leadership Characteristics: I often ask participants to take a few minutes and think who was their most important leader – what were their characteristics? Ethical? Passionate? Positive? Innovative, etc. It’s no different for your followers. They look to you for the qualities. How do you see yourself?

Directional Clarity: Strategic Tasks move people from where they are to where they they’ve never been. Sounds simple? But isn’t that what strategy is really all about? Does your strategy, your vision get your employees excited or does it just sit on a wall. Strategic Planning is the most critical area which will leverage every other area of your organization.

Complex Change Management: Given the economy, business cycle technology and so on, the primary challenge for leadership is to develop a foundation, framework and culture that will be change friendly. This is the primary challenge that all else stems from.

Human Resources: Create an environment of overachievers. Effective leaders know the cost of turnover in their organizations and in performance. Recognize changing needs of employees, the changing workforce and competition. They want the best talent and know how to keep it.

Training: The most effective leaders train. Recognizing this is where you convey your standards, establish your expectations, improve relations, reduce staff turnover and support supervisors. Effective leaders know the importance of recognition.

Succession Planning: By far the majority of managers are better at putting fires out, which reminds me of the 80/20 rule. 80% of managers are reactive and not proactive. We need to expect our managers to lead and train them to lead. Effective leaders do not pick one person to succeed, but conduct complete leadership assessments on all and develop leadership development plans for each. Many use 360 Assessment worksheets to provide a balanced look at the needs of each manager.

Optimization: For years I’ve been talking about optimization and mastery and encouraging exponential growth. These concepts are not new, but even through intellectually we understand, we do not apply. Basically, we all perform certain capabilities, yet some we never master (like a black belt vs. a white belt in Karate).  Others just continue leveraging. Each competency leverages or influences positively or negatively another competency. Master Strategic Planning and it will leverage every aspect of your organization. Master Human Resources and it will leverage the quality of more. Master your budget and it will improve your budget for estimated improvements. 

-Dan Brown, President of Brown Consulting, Ltd.

Will Opioid Addiction get Worse with the American Health Care Act?

Have you been wondering how the American Health Care Act (AHCA) may impact the current U.S. crisis of opioid addiction? Newsweek recently wrote an article outlining the sobering truth about how the AHCA may result in patients not receiving care they need. Addiction is a condition that is treatable. So, why wouldn’t patients receive quality treatment?

Newsweek spoke with Dr. Yngvild Olsen from the Coalition to Stop Opioid Overdose about what patients with addiction may face if the AHCA became law. “Dr. Olsen, who also sits on the board of directors at the American Society of Addiction Medicine, says she may soon contend with the prospects of turning patients away”.

The article discusses how, if AHCA were to become law, the bill would negatively affect substance abuse patients by potentially making substance abuse treatment unaffordable. Essentially, as Dr. Olsen explained, the bill would truncate many of the protections and benefits of the Affordable Care Act (ACA), including medicaid expansion. She goes on to mention that although the opioid crisis is a bipartisan issue, it is also a financial issue. Individual states haven’t had the money to properly handle this opioid crisis. With AHCA’s planned cap on medicaid, this lack of funding would get worse. Under the AHCA, it’s very possible that states would not be able to continue covering funding to adequately treat addiction.

You can read the full article article, written by Jessica Firger,  here.

Megan Phillips, M.A.

Reference:

Firger, J. (2017, May 6). The Plight of Opioid Addiction may get a lot worse with the American Health Care Act. Retrieved from https://www.bostonglobe.com/metro/2017/03/27/changing-attitudes-harder-than-changing-law/8zC7BnYq4mC3SC7amioU2M/story.html#comments

Upsurge in HIPAA Audits

There has been a considerable increase in Health Insurance Portability and Accountability Act (HIPAA) activity. Common HIPAA violations have ranged from stolen workplace computers to misuse of personal health information by contractors. As a result, record setting levels of HIPAA enforcement and fines were documented in 2016.

The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) settled alleged HIPAA violations with 12 healthcare organizations in 2016.  Approximately $23 million in fines were collected by OCR to resolve these alleged HIPAA violations. Seven of these settlements were in excess of $1,500,000 (See:  OCR HIPAA Enforcement: Summary of 2016 HIPAA Settlements). So far, substantial HIPAA fines and settlements have been made in 2017 as well. It appears this upsurge in audits will continue to increase.

What are some basic tips to help prepare an organization for a HIPAA Audit?

1. Run an up-to-date risk assessment that evaluates how vulnerable your organization is to security breaches.
2. Ensure policies and procedures are current and regularly updated.
3. Confirm that your training program(s) are well-managed, active and up-to-date.
4. Triple-check your processes to make sure employees are implementing guidelines. Be certain that employees understand their security duties, how and where all protected health information is warehoused, and are readily able to describe how they act on their compliance duties in their day-to-day work. Specifically, ensure everyone who could potentially be involved in a HIPAA breach process understands their roles when reporting incidents.
5. Make sure documentation is organized and accessible for an auditor.

Brown Consulting, Ltd. can help you guarantee HIPAA compliance!

We have over 30 years of experience helping behavioral health organizations meet HIPAA requirements! Our HIPAA Compliance Analysis involves reviewing your current processes, providing recommendations, and providing you with concrete examples of plans, policies and procedures, forms, contracts, positions descriptions and other documentation to ensure your organization is successful.  Services also include interactive work-groups and training with staff.

-Megan Phillips, M.A.

References:

http://www.hipaajournal.com/ocr-hipaa-enforcement-summary-2016-hipaa-settlements-8646/

Ohio BH Redesign Webinars!

Two webinars will take place this month to further assist Ohio providers navigate the BH redesign. The first webinar is a final overview of the BH redesign, which fully takes effect on July 1, 2017. The second webinar will include an outline of how BH agencies can submit prior authorization requests. Register below:

Behavioral Health Redesign “401” Training – May 22

The Ohio Department of Medicaid (ODM) and the Ohio Department of Mental Health and Addiction Services (OhioMHAS) will host a Behavioral Health Redesign “401” webinar on May 22. This training will serve as a final comprehensive overview of the BH Redesign changes scheduled to take effect on July 1, 2017. The webinar will begin at 10 a.m. and finish around 3 p.m. The training will pause around noon for a one hour lunch break. Click HERE to register. After registering, you will receive a confirmation email containing information about joining the webinar.

Prior Authorization Training – May 23

ODM is hosting a training webinar on May 23  from 1-3 p.m. that will provide step-by-step instructions on how community behavioral health agencies can submit requests for prior authorization for services such as ACT, IHBT, SUD Partial Hospitalization, SUD Residential, etc. Click HERE to register. After registering, you will receive a confirmation email containing information about joining the webinar.

Note: Both webinars will be recorded. The recordings and slide presentations will be posted to the BH.Medicaid.Ohio.Gov web site.

For more information on Behavioral Health Medicaid Redesign, visit http://bh.medicaid.ohio.gov.

Reference:

E. Wandersleben, e-mail communication, May 8, 2017

President Trump announced Nomination for the Assistant Secretary for Mental Health and Substance Use in the Department of Health and Human Services

On April 21st, President Donald Trump announced his nomination of Elinore McCance-Katz, MD, PhD to serve as the Assistant Secretary for Mental Health and Substance Use in the Department of Health and Human Services. Dr. McCance-Katz is a psychiatrist with a sub-specialty in addiction psychiatry with more than 25 years of experience as a clinician, teacher, and clinical researcher. She is currently the chief medical officer for the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals. She served as the first Chief Medical Officer for the Substance Abuse and Mental Health Services Administration (SAMHSA). Read more about the nomination of Elinore McCance-Katz, MD, PhD as well as other key administration personnel here.

Reference: https://www.jointcommission.org/about_us/about_the_joint_commission_main.aspx

Utilizing a Behavioral Health Consultant

You work in Behavioral Health. Your work is successfully making an impact in your community. Why should you hire a Behavioral Health Consultant to assist your organization?

1. You have limited time and resources

You may be an expert on, for example, specific accreditation standards or Medicaid compliance. However, do you have time to ensure every detailed aspect of that project is carried out accurately and effectively? Maybe not. Hiring a Behavioral Health Consultant can free your time.

2. The world of behavioral health is constantly changing. It’s challenging to keep up!

Our consultants stay on top of the latest behavioral health news and trends. We use this knowledge to effectively address your organizational concerns.

3. You can focus more on what matters most….patients

Working in the field of mental health is meaningful. People pursue careers in this field because they find psychology and human behavior interesting. More than likely, they want to help others. Consultants can provide assistance with basic but essential tasks as well as a fresh approach to problem solving and/or pursuing new opportunities. Utilizing a consultant will open up your organization’s time to focus on the patients and community you serve.

Brown Consulting Ltd. specializes in behavioral services.

Brown Consulting controls the shifting landscape of behavioral health by thoroughly understanding the marketplace today and tomorrow. We offer strategy and solutions for our client’s concerns, including but not limited to:

• Accreditation Compliance (CARF, COA, TJC)
• Strategic Planning
• HIPAA Compliance
• New Program Feasibility Analysis
• Staff Recruitment services

Additionally, we offer customized services. Every state is different. Every organization is different. Every problem requires a unique combination of solutions. This is why, as consultants, we will approach your organizational needs individually and guarantee your satisfaction.

-Megan Phillips, M.A.

What is Evidence-Based Best Practice in Behavioral Health?

Behavioral Health Clinical practice guidelines are recommendations for clinicians about the care of patients with specific conditions. Practice guidelines are based on strong available research evidence and practice experience. A best practice is a method or technique that is generally accepted as higher-quality than any other choices. These best practice techniques produce outcomes that are better than results achieved through other options. Many times, best practice techniques take precedence over the minimum effort needed to comply with legal or ethical requirements.

Want to read more about clinical evidence-based best practice guidelines? Click on the following Substance Abuse and Mental Health Administration (SAMHSA) link for a list of organizations’ websites that cover mental health treatment evidence-based practices (EBPs): Mental Health Treatment Evidence-Based Practices (EBP)

Reference:

https://www.samhsa.gov/ebp-web-guide/mental-health-treatment

The Joint Commission Updates

TJC has released the Revisions to Decision Rules and the Post-Survey Process.  The following changes have been made as of 1/1/2017 for all organizations seeking re-accreditation:

1. An organization with a decision of Accreditation with Follow-up Survey will receive notice of full accreditation once it has successfully submitted Evidence of Standards Compliance (ESC). However, a follow-up survey must be conducted within six months to confirm sustained compliance with the ESC.

2. Another change is that the category of Contingent Accreditation has been eliminated, leaving only four possible decision outcomes for currently accredited organizations: Accredited, Accreditation with Follow-up Survey, Preliminary Denial of Accreditation, and Denial of Accreditation.

Please click on the follwing link for further information about these TJC revisions: TJC Revision to Decision Rules and the Post-Survey Process

Remember, Brown Consulting, Ltd. can help your organization with TJC Accreditation Compliance!

Information about the Accreditation Compliance Analysis offered through Brown Consulting Ltd. can be found on the Our Services page on our site.

Reference:

https://www.jointcommission.org/assets/1/18/Revisions_Decision_Rules_Post_Survey.pdf