Podcast: Here’s Why You Need Technology in Healthcare Compliance

Whether it’s an EMR or a compliance software solution, you want technology to do the work for you, not make you do extra work. Knowing where tech disappoints has helped Healthicity’s president, and my guest on my most recent episode of Compliance Conversations, Barry Johnson, D.D.S., to create software solutions that healthcare organizations really want. And, according to the US Government, solutions that healthcare organizations really need.

“Recently at HCCA, we heard government officials telling the people that were at the meeting that compliance has got to move into the digital age and start doing things with software rather than spreadsheets.”

It doesn’t matter if you’re an early adopter or tech-adverse, this informative and fun episode will bring you up to speed on all things healthcare technology from the largest challenges to the newest tools and gadgets that save lives or make your workday a whole lot easier.

“Fitbit and Google...are partnered to explore the development of some consumer enterprise health solutions, and we’re going to see more and more of these combinations of organizations that are doing that. I was just reading today that Current Health announced that they received FDA clearance for their home wearable device that uses AI to remotely analyze patients’ vital signs.” Said Johnson.

Tune into this episode of Compliance Conversations, Taking the Trauma Out of Technology, to learn:

• Tech Trends (and Failures) in Healthcare Technology
• Upcoming Advances in Healthcare to Watch For
• How to Make Tech Work For You (Not the Other Way Around)
• What the US Government Has to Say About Technology in Compliance

Episode Transcript

CJ: Hello everybody, welcome to another episode of Compliance Conversations, I’m CJ Wolf, Healthicity’s Sr. compliance executive, and today I have, probably my most important guest, to date, my boss!

Barry: You have no boss.

CJ: Barry Johnson is here, he’s the president of Healthicity, and I’ve finally been able to pin him down, he’s a busy man, he’s a knowledgeable man, an experienced man, and I’m so grateful that he’s agreed to give us a little bit of his time. Welcome Barry.

Barry: Happy to be here CJ.

CJ: Thank you so much. Barry, what we often do for our listeners is we like to have our guests introduce themselves a little bit, 3 to 5 minutes, tell us a little bit about how you ended up in compliance, because none of us grew up thinking we’d be in compliance. So, tell us your story a little bit.

Barry: Well, my story is that I practiced dentistry for twenty-one years, and after that I decided I didn’t want to do another twenty years of that, so I decided to change professions, and actually we changed locations. We had been living in Illinois for twenty-one sum years, and then we moved to Salt Lake and I went to work part time for a company called medical data research, which was kind of a medical informatics and UCR database company. Over the period of two years I transitioned totally out of dentistry and ended up working for that company. That company joined with another company called, Med-Index, and that company became Medi-Code. They provided databases, books, and all kinds of stuff.

CJ: I remember Medi-Code.

Barry: It was a big company, I had multiple roles in that company. We had a product line of dental services and publications and seminars, and then I learned to be in charge of other things like marketing. Did some work in marketing, a whole variety of jobs, I was there about 9 years and that company was acquired at that time by United Healthcare, and it became one of the Ingenix companies, and at that point I left and took my stock options, and I also, with another member of that company, and we started a business called Health Care Insight, which was basically a software and services group. We did something unique; we were a fraud detection company that would detect fraud prior to the payment of healthcare claims. Prior to that time, on and even concurrently while we were still doing this, there were multiple companies that were doing pay and chase. They would mine claims long afterword’s, and a SAU would go after people that they thought were fraudulent. The problem with software and fraud detection was there is a lot of false positives, so our business plan was we will have good software, but we make sure it doesn’t produce a lot of false positive because we’ll have RN’s trained in detection of fraud and also very clinically minded to review the output of the software.

CJ: Right.

Barry: So, we would get batches of claims overnight, and by noon the next day we had returned all the claims and evaluated them as either suspect or no suspect. That was a very successful business, it took us ten years to get it successful, but it was acquired by Verisk Analytics, and I worked there for three and a half years to run that division of that company, and retired.

CJ: For a second time it sounds like, this is the second career.

Barry: This is the second career, but the first time wasn’t retirement because we had three kids in college when we made that move.

CJ: Fair enough.

Barry: So anyway, I was asked six years ago, now this coming summer, to come to AAPC at that time, to create a compliance software product, and that was to be a temporary part time job, and it turned into basically creating a software division, which was eventually spun off as a separate company, Healthicity. That’s where we find ourselves today, with not only a compliance product, but an auditing product, and an analytics product.

CJ: And all the auditing services, coding, and auditing, and all of that great stuff.

Barry: And the great thing about that was, is we were able to bring several people from our old company that have now become a part of Healthicity. It’s been a good experience.

CJ: And I think you publicly here for letting me have a chance at Healthicity, I’ve been at Healthicity now for four years. When we kind of formally launched at Healthicity, and it’s been wonderful, so I apricate the opportunity. Excellent introduction, I won’t ask what your third career is going to be, hopefully you can get some rest after this one.

Barry: I’ve had a lot of careers in between. I did a little bit of everything working my way through dental school in Chicago. That was the most varied time of employment.

CJ: I’m sure. Well Barry I was hoping I could pick your brain a little bit. As president of Healthicity, we’re a software company, solutions, technology to solve things, I think you have your finger on the pulse of healthcare, what’s going on with innovation, and how that might mesh with compliance. What kind of thoughts do you have on innovation in healthcare and how compliance might be effected?

Barry: I think, you know, you and I were both at the HHCA meeting just recently, and we heard the government officials telling the people that were at that meeting that compliance has got to move into the digital age and start doing things with software rather than spreadsheets.

CJ: That’s right, the OIG, the keynote speaker from OIG, said to embrace technology.

Barry: I think in your experience, and mine, from working with our clients that we can see from that when people do embrace technology, and truly embrace, not just buy it and not use it, which is, and that’s the difficult thing with anything that involves humans. It’s really interesting, I was reading one of the innovations that we’ll talk about briefly, because it’s really not an innovation any more, is electronic health records, or EMR’s, whatever you want to call them. Atul Gawande, who is now the CEO of the Amazon, Berkshire Hathaway JPMorgan joint healthcare thing, he made the following statement, and I thought this was very interesting, he said, of the EPIC system unfortunately, the EPIC system promised to increase my mastery over my work, instead it has increased my works mastery over me. The sentiment that he acknowledged that is shared by providers nationwide, the use of such systems has drastically cut the amount of time physicians spend with patients, and increased their average workday to almost 11 and a half hours. The counter of that, from one of his superiors in this organization, was that the EHR systems were not intended to make it easier for physicians, it was intended to make information available to patients. It’s probably, we’ve heard this complaint, and I’ve been to enough doctors that it’s a period of adjustment. That was my original point, until you adjust from doing the things in the way you have been doing them for years and years, to using software and integrating and embracing software, then you’re going to struggle against it. He said another thing, Medicine is a complex adaptive system, it is made up of many inner connective multilayered parts, and it is meant to evolve with time and changing conditions, software is not, it is complex but does not adapt. And we know that is not true. Because we’re constantly, that’s why software businesses require a lot of investment because we’re constantly adapting software to what people want.

CJ: Client feedback, solving problems to what real clients have in the world of healthcare.

Barry: And you’ve been a key element of that for Healthicity, because you’re interacting with clients and audiences of people, and you know what people want and need, and that has improved our product overall, over the years.

CJ: Absolutely. Well, cool. What other things in healthcare, we all have one of these, I’m holding up a phone folks, and it’s changed life in every way. Probably including healthcare, right? Or it’s going to continue to change. What other innovations, the cell phone, what other things do you see that healthcare is adapting to, or adopting I should say, and there could be corresponding compliance risks?

Barry: I was reading an article a couple of months ago, about the ten innovations that were going to impact healthcare most in 2019, and there are some things on the list, like EHR’s that have been impacting us for years already. Let’s just mention a few of those, and I think the very thing you pointed out first is one of the really obvious phases, or impacts, that is impacting healthcare, is the move to digital, particularly mobile digital devises, and that’s not only impacting the providers that deliver the healthcare, but it’s impacting patients, because now they have access to information.

CJ: Expectations.

Barry: Yeah, greater expectations. I’ve noticed that in my own personal use of information that I can get off the websites of the physicians. There’s ten of them, we won’t talk about all of them, but one of the real things that I see has had a big impact is where health wearables.

CJ: Fit bits and those sorts of things?

Barry: Yes, exactly. I think more and more of those devises are being embraced by consumers. Like monitor glucose, and heart rates, and physical activity, and sleep. And they are taking that information and they are getting a better idea of really what is our understanding of health conditions and what impacts those conditions. Fit bit, that you just mentioned, and google basically are partnered to explore the development of some consumer enterprise health solutions, and we’re going to see more and more of these combinations of organizations that are doing that. I was just reading today that current health announced that they received FDA clearance for their home wearable device that uses AI to remotely analyze patients’ vital signs.

CJ: Oh, that’s interesting.

Barry: Yeah, I just saw that today on modern health or something.

CJ: So folks at home, patients at home, have some sort of wearable, and doctors or nurses could monitor their vitals from wherever. What a great Idea. For conditions where those vitals could be a precursor or some sort of sign or symptom to worsening that could be lifesaving.

Barry: Yeah. That might go totally un-noticed if they weren’t being monitored, and yet that might be something four hours ahead of an incident of some kind that would be critical if you didn’t know about it, and the AI is able to put data together to figure out those things.

CJ: With you saying that, the first thing that came to my compliance slanted mind is, security. Like uh oh, there is a transfer of PHI, a transfer of data, this could get adopted widespread, all this stuff floating around in space and HIPAA security is a big issue, right?

Barry: And just through your mobile device, you could access your personal health record, if you lose your phone, is that going to be encrypted, is that going to be protected if any of it is stored on your phone. But they’ve already covered that, and of course it’s Apple that has done something, and we could talk about that in a minute here. But while we’re talking about artificial intelligence I think it’s interesting, I also read just the other day, a company called mint.com, has nothing to do with healthcare, they were just given a 5.2 million dollar grant to use AI in emergent development AI applications for emergency use to more rapidly diagnose based on symptoms, based on bio signs.

CJ: Artificially intelligence. So the robots might actually take over, and in a way it could really help, right?

Barry: Yeah, and I think a lot of this is driven by the efficiency that it will introduce, and the reduction in cost. I think that’s what’s driving a lot of it. That through the use of technology you can actually reduce cost in healthcare.

CJ: Yeah, if there are things that the computer, or artificial intelligence can do to lighten this burden or load, this intellectual burden or load on a physician or dentist, so they could focus on what their professional skills are, I think that would be welcome.

Barry: I mentioned that Apple was doing something, that’s actually a project that their doing with their IT health app, and their integrating patients medical records from EHR systems, and integrating that, and it’s available on their phones, and the way they secure it is it’s protected by their apple ID, which we hope is secure.

CJ: Well I’ve seen those commercials, I don’t know if you’ve seen the commercials where they, I think they are hilarious, it’s just great advertising, about the person keeping things personal, and then the commercial ends with the apple showing how they are locking down information.

Barry: Yeah, apparently there is enough assurity that it is safe, that they have partnered now with Johns Hopkins, UC of San Diego Health, and even Cleveland Clinic has partnered with apple on that project.

CJ: Folks I have to stop Barry here, because this is why I love talking to him, because he’s always looking forward, because things that he’s saying today will come to fruition in a couple years. He’s very good at anticipating, you and I were talking about something, now I forget what it was, that you and I discussed like four years ago, and you were like this is where things were going to go, and we were just discussing how things have gone there, and have gone beyond there now.

Barry: Not that I’m a great prophet or anything, but I think some things are very obvious, like we….

CJ: But you have to stop and look at them! And if, people like me were stuck in our books and we’re looking at compliance this and this, that’s why I think it’s great to talk to someone like you because you are thinking forward and looking forward.

Barry: Yeah, well thanks. I enjoy doing that, but I don’t have to do the work you do so I have time to do that. But one of the things that was really obvious to me was the wearables. We looked at this, one of our sister companies in the holding company that we belong to is a certifier of EHR systems, and that was an obvious situation where we hired a contractor to evaluate where wearables were going, I think this was about 4 years ago.

CJ: I think this is what we were talking about.

Barry: I think it was, and we paid for this analysis, and basically the analysis came out and it said you’re about two years ahead of the curve, and if you invest in this, you’re going to have to go in with a partner, and we suggest you go in with a partner like Apple or like Microsoft, and that’s exactly what’s happened. We, I don’t say we, as me, but the powers that be, decided that it was too far ahead of the curve to make the investment, but now you look back on it and you think why didn’t we do that.

CJ: Yes, that’s the one we were talking about.

Barry: Yeah, that’s the one we were talking about, and one you were talking about today is healthcare transportation, so tell us why that’s a compliance issue.

CJ: Yeah, so we’ve had clients that are in this space that are, that their main focus is to help patients connect with providers via transportation. So, they are almost like Uber or Lyft, I’m not saying those are the companies.

Barry: Actually, Uber and Lyft were mentioned in the article I read about.

CJ: and it’s partnering with them in non-emergency, so we’re not talking ambulances here folks, but non-emergent transportation. But from a compliance perspective those companies are getting PHI, name, address, etc. of a patient or potential patient, to these travel partners, so that could be a compliance risk that they need to make assessments of their security and privacy practices and those sorts of things.

Barry: The article that I read said there was like a hundred and billion dollars a year wasted in healthcare services because 25% of poverty level patients miss appointments, and here’s why I can go back to my experience in Chicago when I was going to school. In the summer, one summer, I drove a taxi, and one of the major things that I did was transport people from their apartments to the hospital or to a doctor appointment, sometimes even to buy grocery. But the point is, is that, that’s the only means of transportation, there were Lyft or Uber or anything, they couldn’t take public transportation, so we had to drive those people to their doctor appointments. It was the only options they had, and you know exactly, I took one patient to, once a week, he went twice a week, but I only took him once a week, somebody else took him, to a kidney dialysis unit at the VA hospital. He was so ill that I would walk him upstairs and we took him up in the elevator, and I had PHI, before there was PHI. But you can assume that similar things like that are going on.

CJ: Absolutely. Yeah. Fascinating. Any other innovations you want to talk about?

Barry: I think one of interesting that is interesting, the last one I think we probably need to talk about, maybe there is another because I think that’s what, something I had to even look up what this meant. But anyway, vertical integrations in healthcare, we’re use to horizontal integrations, where this practice buys this practice, or this practice is bought by a hospital. Vertical integrations are when a pharmacy buys an insurance, a pharmacy company, buys an insurance company. For example, like CVS’s take over of AETNA, and by the way I just read that AETNA laid off 4% of their employees today, which is an interesting thing, but I think you see that any time there is consolidations, but Optum acquired Davita, Humana and Kindred Healthcare, Cigna and Express Scripts, all of those are vertical integrations, and the thought is that by involving the supply chain you can more economically manage expenses. If I’m a hospital, or I’m an insurance company and I own a pharmacy company, a pharmaceutical manufacturer, then I can be forced to use their products, and maybe control costs.

CJ: So would this example fall into that, here locally, in the intermountain west, Intermountain Healthcare is a wide provider, and they have announced their plans to make drugs.

Barry: Yes.

CJ: Generic drugs.

Barry: Instead of buying something as Intermountain Healthcare, why not just make them.

CJ: We know these are the drugs, we can make it cost efficient. Is that vertical integration?

Barry: That’s vertical integration, without actually acquiring something, they are just building it. Which we know they have done the same thing with a lot of the software tools that they use, they just build it. Umm, bock chain, do you know what block chains are?

CJ: No…

Barry: Neither do I. I had to, I read several articles about it, and I still didn’t understand it, so I went to bock chain for dummy’s on a YouTube Video, I ended up watching several video’s to even figure out what it was, I even asked one of our guys in our IT department what it was, and he couldn’t explain it to me so that I could understand it. Anyway, essentially it is the ability to aggregate data, and store that data across multiple different servers in an expanded network. If the three of us were users, we could all be sharing data, and we weren’t depending on a centralized repository of that data. The block-chaining is a very complex thing that I couldn’t fully explain, but I think I understand it now, that allows you to link, the chain links are linking pieces of data together, then that data is validated by other people in the expanded group, and the problem is, is if something is bad data, and it gets validated, it has to at some point get unvalidated. But this is one of the big growing things in healthcare, because you no longer have to depend on the central source of the data, it can be deployed across multiple different servers, and you don’t need to go through an intermedia. Interestingly enough it was originally developed as a concept for bitcoin distribution.

CJ: Interesting. Could it be used potentially, let’s say you have 12 major cancer centers across the country, and if they somehow shared clinical data, to be identified or something, that multiplying of those data sources can help.

Barry: Yeah, and everybody can add to it, and there is a system where people get rewarded for identifying, or solving, a new solution that needs to be added to the block, that will expand and everybody will get it if everybody will get it if they are a particular type of user, it’s way too complicated for me at this point, but it’s interesting. It was like number 5 or 6 on the list of things that are innovations in healthcare.

CJ: Maybe when the podcasts are over maybe I should ask what stock I should buy, I’m not sharing that with the rest of you, he has good insights. Okay, enough with innovation, we’re getting kind of close with our time here, I wanted to make sure that our listeners heard some of your thoughts on leadership. So, folks, when I’m in our leadership meetings, and we sometimes have offsite team building meetings or sharpening the saw type of thing, I really appreciate Barry’s insights to thoughts on leadership, human nature, success, team building, those types of things. So, I did kind of throw him a softball and said be prepared to share a good quote or two and expound on it, and thoughts.

Barry: Well as you know from our last meeting, I love Steve Jobs, as everybody does. Not that I would have ever worked for him.

CJ: No, but an amazing example of what he accomplished.

Barry: He is an amazing example of somebody that wasn’t following the rest of the tribe down the street. He is one of those geniuses that comes along once in a generation probably. This, I have a quote that I have selected because, and actually I’m going to use two quotes together, because they are two of my favorite, he starts out, “Don’t be trapped by dogma, which is living with the results of other peoples thinking, don’t let the noise of others opinions drown out your own inner voice, and most important, have the courage to follow your heart and intuition, they somehow already know what you truly want to do, everything else is secondary.” And I love that.

CJ: That’s great.

Barry: And another one, where he quotes someone else’s famous quotations, and he talks about, and I always think about this moment, when we’re talking about what are we going to build in this particular application, we go to the clients, go to the prospects, ask them. But sometimes that’s not always the answer.

CJ: Sometimes you want create them something they don’t know they need.

Barry: So, you can’t go out and ask people, you know what the next big thing is? There’s a great quote by Henry Ford, he said “If I’d have asked my customers what they wanted, they would have told me a faster horse.” And I think, who would have ever told him to invent the iPhone, or the iPod or any of the apps.

CJ: Who would have thought we needed it? He told us we needed it, because he took something and he created it and then yeah, yeah, we need that. Isn’t that amazing?

Barry: And I think as leaders it’s your responsibility, and as servants to your customers, it’s your responsibility to always be thinking, what’s the best solution to this problem? What can I do for you, what can we do for you to improve your life?

CJ: Yeah, that’s great advice. Now we have a lot of compliance officers and compliance professionals listening, and as you were reading that, kind of follow your heart, don’t listen to other people’s dogma, I was trying to think, yeah, that does apply to my compliance experience at least, because sometimes as a compliance officer, you just have to follow your gut. No one really loves you, they see you, that’s not always true, we build relationships and they see the value of our partnership, but they don’t run to you, you kind of have to show your own way, and follow your heart on those issues, this is obviously on a grander scheme of that quote, but I think it kind of applies to any job that you do, right?

Barry: Well I think it’s applicable, we’ve introduced, we’ve talked about a few of the ten things that are innovations this year, and that is going to take a decision on many compliance officers part, to say how are we going to be compliant with guidelines right now with these new things that we’re faced with, these new challenges, these new capabilities.

CJ: Yeah, that’s a great point, I actually am speaking with a colleague of mine in October on one of those things on telemedicine. People want to adopt it; I actually was in a hospital yesterday and they had a poster up and it was virtual visits via your phone. $49 for this, you know, so it’s a way, and if they don’t give you any treatment, they don’t charge you. So this virtual, we started with this a little bit, with this expectation of living on our phones and getting things when we want it, I think that is, that whole area tele-medicine is going to blossom, and that’s what we’re going to speak on in October, to try and help people prevent any missteps from a compliance perspective at least.

Barry: Even CMS is even recognizing that that is an option, you know. We have a fee schedule for it now this year, we have procedure codes that didn’t exist. I remember, that’s another thing we looked at two years ago, a tele-health possibility for an acquisition we were looking at, and everybody decided that they didn’t know how they would get paid, and here we are two years later, and there is codes, and there is dollars from the government.

CJ: Interesting. Well Barry, thank you so much for your time, do you have any parting words of wisdom?

Barry: Be compliant, don’t be complacent and don’t be fraudulent. That’s the other thing I read every day, the list of people convicted of fraud by the national healthcare anti-fraud association, and the interesting thing about that, there’s a trend I’m noticing now, it’s now just the 10 billion 5 billion, 60 million dollar fraud, I saw one yesterday for $536,000 that someone got a 3 year sentence for.

CJ: That’s right. They are not just focusing on those big dollar awards, they are focusing on bad actors, and that is really good advice. In this world of technology, I come back to somethings I learned in compliance from my physiology days, a lot of compliance is just human nature. Understanding humans and what pushes their buttons and what, you know, makes them tick. That coupled with technology and all these things we’re doing, but there is always going to be that human nature. Thank you so much for shedding some light on what’s going to be happening. Folks listen up, this is a good one to maybe listen to again, and Barry we appreciate your expertise. Everyone until next time, Be Compliant. Have a good day.