Dr. Jayne on Corporate Compliance and Health IT
Explore the challenges of corporate compliance season in healthcare with Dr. Jayne, discussing mandatory training programs and health IT.
Expert Opinion
As I'm slogging through my own set of corporate compliance training programs this season - I've already done four "Medicare Fraud, Waste, and Abuse" training programs in the last week, and I'm starting to feel like I could teach the class - I'm reminded of just how much variability there is in the way these programs are delivered. In my experience treating patients in a variety of clinical settings, I've seen firsthand how a well-designed training program can make all the difference in terms of compliance and patient care. For instance, the fact that just one of my employers offers a choice of modalities - video versus reading a transcript - highlights the fact that we need better recognition of different learning styles when we're considering our corporate training offerings. A colleague in medical education recently shared with me that they've started using interactive modules with real-life scenarios, which has led to a significant increase in engagement and retention - and I think that's an approach we should be considering more widely.
Key Clinical Insights
Standardization of Training: The lack of a single national training or certification program means that clinicians like myself are forced to complete multiple training programs from different entities, which can be frustrating and inefficient - and it's not just about the time it takes, but also about the variability in quality and content. For example, the fact that some programs require videos to be watched at normal speed and in one sitting can be a significant barrier for those with busy schedules or different learning styles. In my view, we need to work towards standardizing these programs to ensure that all clinicians have access to high-quality, relevant training - and that's arguably a key step in improving patient care and reducing errors.
ICD-10 Code Updates: The annual updates to ICD-10 codes, which become effective on October 1, require significant behind-the-scenes work to ensure a smooth transition - and it's not just about the codes themselves, but also about ensuring that providers understand the nuances of the changes. For instance, coding and billing experts should share information with end users in the weeks leading up to the transition date to minimize disruptions and ensure that providers are equipped to use the new codes correctly. I've seen this play out in my own practice, where a delay in updating our EHR system led to a significant backlog of claims - and it's a reminder that we need to be proactive in addressing these changes.
Rural Health Initiatives: The recent approval of $50 billion in assistance for rural health projects is a significant development - and it's not just about the funding itself, but also about how it's allocated and used. The fact that states will have flexibility in how they use these funds to augment their own rural health initiatives is a positive step, but it's also important to ensure that these funds are used to supplement existing state-level funding, rather than simply replacing it - and that's a key consideration as we move forward. In my experience, I've seen how a lack of coordination between federal and state funding can lead to inefficiencies and duplication of efforts - and we need to be careful to avoid that in this case.
Workforce Development: The program's focus on workforce development is crucial, given the significant challenges that rural health facilities face in recruiting and retaining healthcare professionals - and it's an area where I think we can make a real difference. For example, the fact that some states have many rural health facilities, while others have few, highlights the need for targeted approaches to workforce development - and we need to be thinking creatively about how to address these challenges. In my view, this is an area where technology can play a key role, whether it's through telemedicine, online education and training, or other innovative solutions - and it's an area where I think we should be investing more heavily.
This changes the game for rural health initiatives, in my opinion - the fact that we're seeing a significant investment in these programs, combined with a focus on workforce development and flexibility in how funds are used, suggests that we're moving in the right direction. However, I'm skeptical that we'll see immediate, dramatic improvements, given the complexity of the challenges we're facing - and we need to be realistic about what we can achieve in the short term. As I chat with colleagues over coffee, I'd tell them that while there are certainly challenges ahead, I'm cautiously optimistic about the potential for these initiatives to make a real difference in the lives of patients and providers in rural areas - and I think that's something we should all be excited about. That being said, I'd also caution that we need to be careful about how we allocate these funds, and ensure that we're using them to supplement existing state-level funding, rather than simply replacing it - and that's a key consideration as we move forward. Overall, I think we're on the right track, but we need to be careful, thoughtful, and strategic in how we approach these initiatives - and that's the key to making a real difference in the long term.
⚙ Clinical Key Takeaway
The upcoming October 1 ICD-10 code updates will affect nearly all healthcare providers, with over 1,000 code changes, additions, and deletions, and it's crucial to ensure a smooth transition by educating providers on the nuances of these changes, with a focus on the 274 new codes and 30 deleted codes. This change will impact the way we document and bill for patient care, and it's essential to stay up-to-date to avoid any disruptions in revenue cycle management. According to the article, the transition involves more than just code changes, and coding and billing experts should share information with end users in the weeks leading up to the transition date.
The ICD-10 code updates will affect a wide range of patient populations, particularly those in rural areas, where the recently approved $50 billion in assistance for rural health projects will be disbursed. The article highlights that the initial phase has states applying for funds to augment their own rural health initiatives, which will impact patients in these areas. Specifically, the article mentions that several states have a history of accepting federal funds and then cutting pre-existing state funds, which can hinder the progress of rural health projects. Patients in these areas may be more vulnerable to disruptions in care due to the code changes, and it's essential to consider their needs when implementing the updates.
For patients with complex medical conditions, I'd now consider reviewing the updated ICD-10 codes and ensuring that our EHR system is compatible with the new codes, based on the article's mention of the 274 new codes and 30 deleted codes. I'd also recommend providing education to our providers on the nuances of the annual changes, as the article suggests, to ensure a smooth transition and avoid any disruptions in patient care. Additionally, I'd consider reaching out to our coding and billing experts to ensure that we're prepared for the changes and can provide the necessary support to our providers and patients.
EPtalk by Dr. Jayne 9
EPtalk by Dr. Jayne 9/25/25
Autumn has arrived in the US, and with it the corporate compliance season. Nearly all the companies I’ve worked for do their mandatory training programs in September, October, and November, so I’m getting hit from all directions.
For those of us who have a patchwork of clinical employment and appointments, it means doing training programs from different entities. There is no single national training or certification that everyone can follow.
I’ve done four “Medicare Fraud, Waste, and Abuse” training programs in the last week, and I am at the point where I could teach the class. Online offerings range from “read this document and take a quiz” to videos that have to be watched at normal speed and in one sitting, which adds to the frustration.
Just one of my employers offers a choice of modalities (video versus reading a transcript), which highlights the fact that we need better recognition of different learning styles when we’re considering our corporate training offerings. Today I’m planning to tackle all my HIPAA training, so wish me luck.
It’s also the time of year when organizations update their ICD-10 codes since updates, additions, and deletions become effective on October 1. Changing codes is usually invisible to users, although depending on the EHR and revenue cycle management systems, a fair amount of behind-the-scenes work can be required.
Ideally, the transition involves more than just code changes. Coding and billing experts should ensure that providers understand the nuances of the annual changes. They should share that information with end users in the weeks leading up to the transition date.
Early in my informatics career, it was my job to write the provider bulletin that would highlight some of the new codes. Although that was important work at the time, in hindsight it seems a bit dull compared to the AI projects and large strategic projects I’ve had my hands in more recently.
Details about disbursement of the recently approved $50 billion in assistance for rural health projects are becoming public. The initial phase has states applying for funds that they can then use to augment their own rural health initiatives.
It’s always interesting to see how things go once the money starts flowing. Several states where I’ve lived practiced the bad habit of accepting federal funds for something and then cutting any pre-existing state funds. That doesn’t do much to move projects forward compared to applying federal funds in addition to existing state-level funding.
Rural health varies widely across the US. Some states have many rural health facilities, while others have few due to denser populations. How the funds are allocated will be telling.
The program has five strategic goals that vary in their vagueness. They range from “make rural America healthy again” to “workforce development.” States will employ different approaches to goals like workforce development, recruiting, and retention given the challenges of working in a rural environment.
I’ve practiced primary care in a rural setting and it is daunting. Being a family physician without a lot of subspecialty support requires you manage more conditions than in a suburban environment or at an academic medical center. Some of my rural friends are on call nearly 24/7, which is not necessarily attractive to new graduates even though they might find the environment both challenging and rewarding.
Increasing pay, not only for physicians but for all members of the healthcare team, would improve recruiting. It would require more than $50 billion to do that in a meaningful way in the US.
Other somewhat nebulous focus areas involve “the growth of innovative care models” designed to improve outcomes and “promote flexible care arrangements.” I’m hoping that these phrases aren’t used to advance programs that lead to increasing numbers of less qualified providers in rural areas. A couple of states have put together programs to increase access that allow physicians who are not fully licensed to practice in rural areas.
As someone who did a specialty residency in primary care, I would argue that just because one graduates from medical school doesn’t mean they are qualified to care for patients in the rural environment. I come from a long line of rural folk and have seen the health challenges they face. We need to make sure that we are incentivizing our best and brightest to go to those areas rather than just trying to supply warm bodies with incomplete training.
There is room for innovation in telehealth, team-based care that might involve subspecialists consulting remotely and other worthwhile areas. I hope we see plenty of those in funding proposals.
States must submit applications in by early November, so the timeline will be tight since awards will be announced by the end of the year. Are you involved in proposal submissions? What kinds of projects are on your wish list? Do you think your odds of being funded are good? Feel free to leave a comment or drop me an email.
A recent study caught my attention. It highlights how low-tech interventions might be better than high-tech ones. It found that when trying to identify health-related social needs such as housing instability, transportation needs, or food insecurity, simple questionnaires were more effective than advanced machine learning techniques. Using a combination was even more effective. The study examined 1,200 patients from two health systems in Indianapolis and included techniques such as using natural language processing of clinical notes to identify health-related needs.
Many of the clinicians who practice the US were trained in an environment where social determinants of health weren’t routinely covered. They have gradually been added to curricula, as research has shown that the environments in which people live and work have a significant impact on health outcomes and quality of life.
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