OIG seeks feedback on physician model plan
Federal Register notice takes industry by surprise, but the proposed model plan isn’t a done deal yet
Last week, the Health and Human Services Office of Inspector General (OIG) published a solicitation for comments on the possibility of developing a model compliance guidance specifically targeted at physicians.
The notice, which appeared in the Federal Register last Wednesday, came as a surprise to many in the health care industry, given that earlier this year, the OIG argued that the previously released model compliance guidance for third-party billers provided sufficient guidance for physician practices. (See "Protect yourself with billing company's compliance plan," Physican’s Compliance Hotline, Jan. 19, 1999, p. 1.)
L. Stephan Vincze, president and CEO of Vincze & Frazer in Atlanta, who worked on the third-party billers plan, says he doesn't see the need for a new plan designed specifically for physicians. "I would suggest that the third-party billing compliance guidance is more than sufficient to address the billing issues that physicians face," he says. "While there are some nuances relating to physicians that perhaps could use some further explanation, I know that those of us who worked on the [billing] guidance — both in the private sector and within the OIG — wrote it, drafted it, and edited it with physicians in mind. It's not as if it was created with someone else in mind and now is been [applied] in an area where it really doesn't belong."
Creating a new compliance guidance for physicians would be both time- and labor-intensive, as well as expensive for the government to develop, Vincze argues. What's needed, he says, is further education in the medical community about how the existing plan applies to physicians and how they should use it to develop effective compliance policies. "I think if that's done more clearly by the OIG, then there'll be less of a clamor for more guidance."
Another surprise for some industry experts is the fact that the OIG is soliciting feedback not just about the content of a possible physician compliance plan, but whether such a plan is even necessary.
"This is the first time we've done this," says Ben St. John, a spokesman for the OIG. "With the first two guidances for clinical laboratories and hospitals, we worked closely with the specific provider groups to develop a plan. Then we decided to open up to the public, . . . issue a draft guidance, get comments, and then do a final version of the guidance. This time, we're asking, 'Is there a need for the guidance to begin with?' If so, then we will proceed with the development of a draft program of guidance and do a final version."
St. John acknowledges that until recently, the OIG believed the third-party billing compliance guidance "would cover most of the issues that would be of particular concern to the physician community." And, indeed, Vincze says that as recently as a month ago, sources close to the OIG had maintained that no separate physician guidance would be developed.
What prompted the OIG to shift its position and entertain the idea of crafting such a guidance remains unclear. St. John maintains the move was prompted by "members of the physician community" who questioned whether the third-party billing plan fully met their needs. "Some in the physician community believed that there should be specific guidance; we want to survey the community to get a good sense of whether they feel there would be a benefit to our developing this. And if so, what are some of the specific issues they would like us to address?"
Vincze finds it difficult to believe that physicians themselves would actually request a new compliance plan. "I'm not sure this is really bubbling up from the grass roots of physicians," he says. "If you polled physicians in their offices, I'd be surprised if they said wholeheartedly, 'Yes, I want more guidance from the government.’ In the past, by and large, they've always said, 'Leave us alone.' I think this is coming from somewhere else."
He speculates that the push to create a physician's plan is being driven at least in part by "groups representing physicians that want to have some kind of increased leverage or say in the process."
St. John acknowledges that the OIG has maintained "continuous dialogue" with the various professional organizations. "And I'm sure that it's through these exchanges that we were prompted to do the solicitation, to say, 'Let's get a sounding from the physician community at large as to what their needs are, and how can we best serve those needs?'"
The solicitation itself offers little clue as to what form a physician compliance plan might take, although if one is developed, it likely will focus on individual and small group physician practices. And like every other compliance plan developed to date, it will include the OIG's usual seven elements for a comprehensive compliance plan:
1. The development of written policies and procedures.
2. The designation of a compliance officer and other appropriate bodies.
3. The development and implementation of effective training and education programs.
4. The development and maintenance of effective lines of communication.
5. The enforcement of standards through well-publicized disciplinary guidelines.
6. The use of audits and other evaluation techniques to monitor compliance.
7. The development of procedures to respond to detected offenses and to initiate corrective action.
The OIG specifically wants comments and suggestions regarding possible risk areas for individual or small group physician practices, as well as aspects of the seven elements that might need to be modified to reflect the unique characteristics of such practices.
The deadline for the comment period is 5 p.m., Nov. 8, 1999. You can mail your comments to: Department of Health and Human Services, Office of the Inspector General, Attention: OIG-7-CPG, Room 5246, Cohen Building, 330 Independence Ave. S.W., Washington, DC 20201. In commenting, refer to the file code OIG-7-CPG.
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