Earlier this month, I wrote a post about a new book entitled The End of Medicine : How Silicon Valley (and Naked Mice) Will Reboot Your Doctor written by Andy Kessler. Today, I had the opportunity to interview Andy as my guest while sitting in as a guest host for my friend Mychal Massie on his show, Straight Talk, which plays on Right Talk Radio. John, at Right Talk, graciously allowed me to download the show in order to reproduce it here. I thank John and Right Talk for giving me permission to air the show at Garlo Ward.

Andy Kessler does a great job on the show and he has some really good insight and information about trends in medical technology and how it will impact us in the future. I also had the chance to read his book and highly recommend it. It’s informative, easy to read and quite humorous. Here is a really good review of the book from the Wall Street Journal.

So, I urge you to click on the little symbol below and listen to the show. It lasts about an hour and is well worth it.

Do You Want a Compliance Plan? You Bet…And You’d Better!

The Office of the Inspector General of the United States Department of Health and Human Services dictates that almost all providers have Compliance Plans. Specifically, the HHS-OIG recently issued its annual Work Plan, indicating where federal investigators will focus their attention in 2006, including but not limited to hospitals, home health, nursing homes, physicians and other health professionals. The recently published 2006 Work Plan, in its entirety, can be found at http://oig.hhs.gov/ publications/docs/workplan/2006/WorkPlanFY2006.pdf.

Okay, But What Is a Compliance Plan?

In sum, a Compliance Plan is the effective implementation of policies and procedures that ensure ethical operations that meet all necessary laws, rules and regulations, particularly HIPAA standards. The goal: eliminating fraud, waste, abuse and inefficiency in your health care operations. And the bonus: an effective Compliance Plan can mitigate sanctions that would otherwise be applied to providers that commit crimes or civil violations however innocently.

A Brief History. In 1984, Congress passed the Sentencing Reform Act, authorizing government prosecution of corporate officers and managers for crimes committed by subordinates, even if the officers were unaware and the acts were against company policy. At the same time, the Act gave company officers a means to reduce their penalties by up to 98% if they complied with “due diligence” standards for fraud control and protected companies against whistleblowers’ qui tam claims if the companies set up internal fraud-reporting channels. These due-diligence standards became structured “Corporate Compliance Plans,” or voluntary internal measures to prevent against fraud and abuse and ensure quality requirements. The HHS Inspector General published final guidance on corporate compliance programs for nursing homes in March 2000, and for small physician offices in October 2000.

Another anti-fraud effort, Operation Restore Trust, was in effect from 1995 through 1997 and targeted nursing homes, home health agencies, and durable medical equipment (DME) suppliers in five states. It recovered $188 million and netted 74 criminal convictions, 58 civil settlements, and 218 exclusions. The Office of the Inspector’s Web site (http://oig.hhs.gov/) lists scores of other nursing homes, hospices, DME suppliers, and ambulance companies, among others, that were excluded or placed under mandatory holds.

In the Wake of Enron. In its ongoing efforts to attack financial fraud and abuse, Congress expanded the Inspector General offices into all 50 states by this year, and gave the OIG additional powers under the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

What Should We Be Doing?

Based on the new Work Plan, all providers should review (or implement) their Compliance Plans, audit current practices, assess risks and weaknesses, update written policies and provide additional training to staff. Implementation of a Compliance Plan not only prevents Medicare and Medicaid fraud, but it also controls against general financial waste and crimes, establishes clear ethical standards, and enhances your company’s reputation for integrity.

The HHS-OIG identifies seven essential components of corporate compliance:

• A general code of conduct describing a clear commitment to corporate integrity.
• A compliance officer with authority to monitor and enforce standards.
• Effective compliance training programs throughout the organization.
• A systematic auditing plan.
• Internal investigation and enforcement using publicized disciplinary guidelines.
• Prompt corrective action plans for identified violations.
• Reporting channels to the compliance officer, including a “hot line.”

The OIG guidelines explicitly encourage variations in plans to fit the size, structure and other circumstances of each provider. More importantly, the November 1, 2004 amendments expand upon these original seven elements and describe in greater detail what an organization must do to implement a Corporate Compliance Plan that effectively prevents and detects violations of law. Your company should consult with attorneys knowledgeable about corporate compliance in setting up an appropriate Plan to meet your needs while complying with federal and State standards.

You can find the HHS-OIG regulations addressing compliance plans online for Nursing homes (oig.hhs.gov/authorities/docs/cpgnf.pdf) and small physician offices (oig.hhs.gov/authorities/docs/physician.pdf).
Should you have any questions, please feel free to contact Jerri Ward or Dana Stripling at dstripling@garloward.com or (512) 302-1103.

A story in the New York Times proposes that the government consider saving Medicare money by having people die sooner(free subscription required to view):

ALTHOUGH Social Security’s fiscal direction has taken center stage in Washington of late, Medicare’s future financing problems are likely to be much worse. President Bush has asserted that the Medicare Modernization Act, which he signed in 2003, would solve some of those problems – “the logic is irrefutable,” he said two months ago. Yet the Congressional Budget Office expects the law to create just $28 billion in savings during the decade after its passage, while its prescription drug benefit will add more than $400 billion in costs.

So, how can Medicare’s ballooning costs be contained? One idea is to let people die earlier. (emphasis added)

I’ve seen clients cited by regulators for failure to provide necessary care and services to a dying person–so there is merit in discussing what degree of life-prolonging care should be given people at the end of life. However, what this article seems to propose is that the government affirmatively do something to withhold life-prolonging treatments in order to save money.

I think that this is a slippery slope.

If the goverment controls such issues–trumping health providers and family–we will have a problem. This sort of “gate-keeping” is precisely what has caused an uproar over HMO’s.

Do you believe that the government will be a better gate-keeper of treatment and services than HMO’s?

If so, I want to introduce you to BLANDINE ALLAKI the daughter and Mister Desmond ALLAKI the sonof H.R.H CHIEF WILLIAMS ALLAKI of the ex- king of mende tribe Nigeria. She has an investment proposal for you.

Moreover, the article points out:

For the last few decades, the share of Medicare costs incurred by patients in their last year of life has stayed at about 28 percent, said Dr. Gail R. Wilensky, a senior fellow at Project HOPE who previously ran Medicare and Medicaid. Thus end-of-life care hasn’t contributed unduly of late to Medicare’s problems. But that doesn’t mean it shouldn’t be part of the solution. “If you take the assumption that you want to go where the money is, it’s a reasonable place to look,” Dr. Wilensky said.

Slippery slope alert!

Making determinations about life-prolonging treatments is complex and delicate. It’s not just about the medicine or the money. It’s also about ethics and morality. Get the government directly involved in such decisions and it will soon be using a backhoe where a teaspoon will suffice. That’s about as complex and delicate as the government ever gets.

Lately, I’ve been thinking about these issues in the context of the Pope. If the government were in charge of determining life-prolonging treatments on his behalf, would he be alive today? Despite his infirmity, he has continued to work and produce writings on such matters as changes in the media and the rise of blogs.

Of course, his situation is far different than the situations of many people today who reside nursing homes. For them, heroic measure such as tracheotomies may not be appropriate.
But the point is, should the decision be taken from you, the family, the attending physician and the community in which you live, and placed in the hands of the federal government?

I say no. In my opinion, if the government makes money the primary consideration in decisions about treatment of the elderly and infirm, our society will begin to devalue the elderly, infirm and disabled.

I keep going back to what Peggy Noonan wrote about the reason the Pope has refused to retire and insists on showing us in his extremis:

What should the pope’s suffering tell us? Several things, said Mr. Novak. He is telling us it is important in an age like ours to honor the suffering of the old and the infirm. He wants us to know they have a place in life and a purpose. He not only says this; he lives it. He was an actor as a youth; he teaches by doing and showing, by being. His suffering is a drama he is living out quite deliberately. John Paul stands for life, for all of life. He wants to honor what the world does not honor.

Those of you who make your living caring for the elderly, infirm and disabled–isn’t honoring the lives of the elderly, infirm and disabled precisely what you do?