How to Transition From a Good Defense to a Winning Offense

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[00:01:13] Welcome to Untold Physio Stories podcast.

[00:01:22] Your perfect commute resource with physio failures, successes, interest in cases and more from the physio and rehab world with your host, Dr. Andrew Rothschild and Urson Ralehioso.

[00:01:40] Welcome back to Untold Physio Stories podcast.

[00:01:43] I'm your host, Dr. E with minor manual therapy, edge mobility system and minor rehab master or four month online mentoring program.

[00:01:49] My co-host, Dr. Andrew Rothschild is not with me but today I have a special guest, Dr. Daniel Hirsch.

[00:01:54] How's it going today Daniel?

[00:01:55] Doing great. Thanks for having me.

[00:01:58] Yeah, so he has a very unique specialty and I'll just let him introduce himself and you can tell us your story or interesting cases and why you think that every peathe or business should really be paying attention to what you have to say.

[00:02:17] All right, awesome.

[00:02:18] Well, you know what? We spoke a couple weeks ago and I was really excited because usually I don't get to speak to people that are amazingly skilled and talented like yourself.

[00:02:29] And I was thinking about why is compliance such a topic that people not only avoid but normally they just they really do not want to give any attention to.

[00:02:39] And I thought that something that would resonate with a lot of you know, owners and practice managers and directors is that it's not always about preventing what's right in front of you right now.

[00:02:52] Just for instance, my background real quick as a physical therapist, I could tell you, you know, patient care really, really important.

[00:02:59] But then when it comes to the other profession that I came from which is property and cash insurance risk management all these are the great things that people usually kind of take for granted and say hey by the way,

[00:03:08] you know, Dr. I already have insurance I already have professional liability with my company. Do I really need my own all these types of questions that's kind of start creeping up right that most people are like maybe I'll Google maybe I shouldn't

[00:03:20] Google all these things all of a sudden start coming coming at the focus I think when you're leading and when you're directing and when you're owning.

[00:03:29] So I guess that's why I find this topic so interesting not only because this is what I do 24 seven right all I do is focus on therapy and compliance, but also because you get results.

[00:03:42] Most people, they have this preconceived idea that it's so expensive. It's really cost prohibitive that it's really not that important and by the way you can just do it yourself.

[00:03:54] The only thing I agree with is that you probably could do it yourself. But why would you because if you want to waste weekends if you want to spend all your Sundays kind of digging through regulations and laws and such and all these great things.

[00:04:07] I don't know if I can see your shaking maybe maybe you do. I don't know.

[00:04:12] But if you want to fantastic, I'll show you exactly what to do. If you don't, you know what, you don't have to recreate wheel and I learned that the hard way where it was really in my practice I said this has to exist.

[00:04:26] I don't want to have to sit through a 15 hour lecture. I don't want to have to go ahead and pay an arm and a leg for experts to come and tell me what to do, and then not give me anything on how to actually do it.

[00:04:36] So I'll give you a couple examples of why this is really important but at the end of the day, it doesn't matter if you use me or somebody else, you should think of compliance as a offensive weapon, not just reactive.

[00:04:49] Oh my God, when something comes up, then I'll deal with it. The truth is that when it comes to an ounce of prevention, right, it really does pay off. That's the whole purpose of having your car insurance, your property insurance.

[00:05:01] Right. What do you the great example of the blind side movie, right? What do you do when you get that quarterback? You got to protect the quarterback. So same thing with your business.

[00:05:09] You wouldn't just put all your effort, you get all this years and years of education. I forget how many courses you told me the first year out that you're knocking out of the ballpark. All these continuing it was some crazy.

[00:05:23] Yeah, I don't know. The first year, the first five years, or five years probably like between 50 and 60.

[00:05:29] That's incredible, right? Most people, you know, most states only require, you know, 30 credits for every couple of years or whatever maybe for CEOs. So you're probably, you know, making someone real happy.

[00:05:40] I wish I could bank it. It's not like I was able to bank it.

[00:05:43] Right. Can't pay it forward. That's a great point. But here's an example of why compliance really does pay off. So it's all about prevention.

[00:05:54] And in my world, when you have to clean up and you have to fix things just like anything else, it's always more expensive to do it. And it's always more complicated to do it.

[00:06:03] So for instance, I love when we talk about incident reports. So an example that I have is we hear all the time about employees. So we have employee issues. We have patients and oftentimes as owners we get confused a little bit about where is my loyalty?

[00:06:19] Where's my loyalty? What do I have to protect? And the answer is, well, you have to protect everything but you have an equal obligation to your staff as well as to your customers, to your patients to make sure that they work in a safe environment.

[00:06:33] We had a case where there was a practice and the staff member was being abused.

[00:06:41] And it was just something where it was a really hostile work environment, but it wasn't because of the practice. It was because a patient kept coming in on a routine basis and physically and emotionally actually taking advantage of a therapist.

[00:06:56] You don't really think of this thing. You don't really would, you don't learn about this in school. This is really something that you would think, hey, by the way, this would never happen. Why would this ever happen?

[00:07:04] We're doctorate level perfection. We're very well liked as a profession as well. Why would someone want to take advantage of anyone?

[00:07:13] And the concern was that there was no reporting. There was no ability for this individual that they felt that they could actually report this to their superior, which even if they were embarrassed by it, the whole point is that it has to be documented.

[00:07:26] You have to demonstrate that you're doing something to protect your employee and it became a really, really messy, messy separation, if you will.

[00:07:33] And you have to go into investigation and then we have to bring in counsel and it became just a very expensive process, just that you could have easily had a process in place such as you fill out an incident report where you have an A and non-spotline, something that is very, very easy to do that you immediately identify the exposure or the risk.

[00:07:54] And again, it was very expensive because once you start adding up legal fees, you know this. The clock just starts ticking, right? All of a sudden all these expenses just start adding up. Another example in terms of what we've been seeing in the last colleague.

[00:08:10] Yeah, go ahead.

[00:08:11] Sorry, my camera dropped. Let me ask you a quick question though. Did the owner or did the employee end up contacting you? Like how did this even go about that?

[00:08:20] So the owner actually had to contact, yes. Because they were looking for expertise in this area of risk mitigation and they didn't want to go directly with counsel.

[00:08:29] Yeah.

[00:08:30] So they're looking for someone that had experience like myself. So again, this is something where you don't think why would this ever happen? But things always happen.

[00:08:39] There's always things that are happening. And of course you wouldn't see this on the front page news. You see these high profile cases all the time with the Department of Justice where improper supervision or improper billing, things that we hear about.

[00:08:50] Where people get caught. But the other things that are constantly happening, you're not going to read that in a court of your report from ATI or USPT, right?

[00:08:58] These are not things that are going to be reported specifically because they're internal. They don't want to release it. It's very embarrassing too.

[00:09:04] So this is something that you really, really want to have a phone a friend or someone that you could actually trust, a trusted resource to say, hey, by the way, what do I do with this?

[00:09:13] How do I move forward? What process should I put in place? And the answer is, it's very simple. Just do and we give you actually, we give you tools to actually do this kind of risk mitigation.

[00:09:24] Another incident where we had an audit. We were talking about audits in the last probably about six months Medicare has been very, very aggressive.

[00:09:36] I don't know if you know this, Dr. But like it's been across the board. It doesn't matter where you're located. Medicare and other commercial payers are really heavily auditing right now.

[00:09:46] And in one practice that we were working with, they had a huge error rate is amounts of error rate, and it became a multimillion dollar take back.

[00:09:55] So the insurance company came in and said, hey, by the way, we're taking back millions of dollars because of X, Y and Z that we found.

[00:10:04] They didn't have a process in place to actually screen this in the first time. So there were preventable things that could have avoided all this chaos and anxiety and a lot of stress for the company.

[00:10:14] And what we did is we put in, we just went, we worked overnight one night. We actually got this notice and we said, oh my gosh, we got to deal with this.

[00:10:20] So we actually went through line by line and we put entire night's work through. And the next morning we actually appealed the claim and had all the claims actually reversed.

[00:10:33] And there was millions of dollars that were actually released, but it wasn't just that. It was the consequences that followed because what happens, a lot of people don't realize this is that when you fail audits, your error rate actually dictates what happens next.

[00:10:46] So just because you think, ah, you know what? It's only a couple hundred dollars or a couple thousand dollars. I'll just pay it and move on.

[00:10:53] If you have a significant error rate, you're just coming up next again.

[00:10:57] You're just getting replaced on that list again for other either commercial payers or if it's federal, all the federal payers are all seeing this information.

[00:11:05] So it's really important that people understand it's not just, hey, by the way, I could just pay this off and just let it go away.

[00:11:10] But having something in place, that was the whole point that they didn't have something in place that could have easily prevented these claims that were denied.

[00:11:19] So again, people make mistakes. I'm a big believer and you know, it's fine. It's okay.

[00:11:25] Another example of something that we see a lot is with cyber.

[00:11:33] So right now you probably can't go a week without reading something about a cyber incident in the news right now.

[00:11:39] I think the last one was a large cell phone company who just released basically all of our information again.

[00:11:47] Well, that was a big one but also change healthcare or something that's directly affecting us, right?

[00:11:52] Well, it's the largest in US history. Yes, it's massive.

[00:11:55] So we don't even, I mean this is just the tip of the iceberg. We don't even know right?

[00:12:00] We're only a couple months into this or a couple weeks, whatever it is. It's very recent.

[00:12:04] I think it's over a month now.

[00:12:06] It's very, very new. So these things usually take months to even actually properly discover for like forensic auditing.

[00:12:14] You need a lot of resources to actually go in through and figure out where the exposure is, especially downstream.

[00:12:19] So what do you do internally?

[00:12:23] So let's say you're a small mom and pop or you're midsize or even a large, you need processes in place to make sure that your network is secure.

[00:12:30] So a lot of times owners or whoever's wearing the compliance hat or the privacy hat, they don't really know what to do if something was released or something accidentally.

[00:12:39] You know what? I gave the wrong record out or oops, something got stolen out of my car or oops, right?

[00:12:43] All these things you think nothing ever happens, you'd be shocked how many laptops have they gone missing on a Friday afternoon when someone walked into a food store or somewhere.

[00:12:53] These things happen all the time and you have to address it.

[00:12:57] It does happen all the time. Like I get medical records, requests for a patient I've never seen before, ever, or I get a DME request for someone I didn't sell something to or I get someone's records.

[00:13:13] That's a me that I've never seen before.

[00:13:16] Right. Luckily you're a covered entity, so that's usually a good thing.

[00:13:20] So the problem is it's very timely. The clock literally is ticking when something happens and has to be dealt with immediately.

[00:13:26] And that's really the strength where you want someone that is not going to take three weeks to get back to you.

[00:13:31] You need something immediate.

[00:13:33] And that's not a shameless bug, but that's really where our strength is.

[00:13:37] We've really, really focused in on being readily available.

[00:13:40] Whenever someone needs something, we are able to immediately address the not just the root cause, but to address what's the severity?

[00:13:48] What are we actually looking at? What resources do we need to bring in to actually deal with this in a meaningful way?

[00:13:53] And again, just from a breach, you said yourself it does happen and the reporting of it and the financial consequences of it.

[00:14:02] It just escalates. It just compounds.

[00:14:03] So do you have to notify your insurance carrier? Do you need cyber insurance? Do you have an umbrella policy?

[00:14:09] All of these things start coming into play where if you just simply would have maybe addressed this on a yearly basis that you simply could go down through a checklist and say, Hey, by the way, have I done this?

[00:14:19] Have I reviewed this? We actually give you the tools to actually do all this.

[00:14:22] I don't want to say meaningless, but it's really meaningful because it will help prevent issues down the road that again, it's not unforeseeable.

[00:14:33] These things, of course they happen. People make mistakes and we're just people. We deal with patients.

[00:14:38] Certain, you know, I love the story of like, you know, they had almost the exact same name. They had the same birthday.

[00:14:44] It was so easy. Anybody you would have made the mistake, I would have made a mistake and proof there goes, you know, X amount of number of records to the wrong person.

[00:14:52] So that's something that is we want preventable strategy in place from a from a risk management standpoint.

[00:15:01] And again, I think driving costs, a lot of people think this is so expensive. Oh my gosh, I need a whole compliance scheme. Oh my gosh.

[00:15:09] You know, I've worked at a large company or where do I even start the whole idea is that this should really, really be affordable.

[00:15:17] The whole argument of like, well, there was a there was a barrier. There was a cost that would prevent me from actually taking the reasonable steps that really have a program in place those days historically they're gone.

[00:15:32] So we actually solve that solution for people and actually give them exactly what they need for compliance just right on demand, which is pretty cool.

[00:15:41] Yeah. I mean, when he told me how much like, I don't know if it was like an audit or a program or information when you told me how much it cost actually couldn't believe it and I'm not just saying that to plug you but

[00:15:54] you know where can people find you because I think this is something that everyone should look into. I used to be a clinical peer reviewer. I used to do those audits and I know that people just think like, oh, I have a great EMR and my it generates amazing notes.

[00:16:10] Well, it might generate amazing notes but you can still abuse those notes and I, you know, I think I told you Daniel that I've seen like there was a couple practices in a couple one or two providers, particularly in New York City that I used to audit all the time.

[00:16:23] And they would always say like why is Secretary of State always yelling at me like why are you doing it? I don't even care. I'm like literally this guy copies and paste every single one of his notes.

[00:16:32] He generates one good note and then the next 20 notes are all exactly the same and I can't, he's not even changing anything. Like I expect minimally 20% change in the note, you know.

[00:16:45] But and I said like, you know, your EMR doesn't protect you from being audited. Your EMR may generate a nice looking note and it may include things that an auditor would want to see but you still have the right information that will prevent you from getting from failing an audit.

[00:17:00] Yeah, and Medicare from their mouth actually said that last month on every quarter they do these sessions. So anyone is free to anyone they don't work they don't record them but every quarter they have a Medicare Part B for PT and OT.

[00:17:13] The next one's April 11 I believe, and they actually specifically said this that they were really really dialed in on these templates and these forward options that EMRs are strategizing right now and they really really are enforcing this copy forward nonsense that they're saying just because you wrote it to your point.

[00:17:30] And so, you know, it's a really great note one day. It has to be unique to show and demonstrate medically necessary services on every single visit. And if you're just copying that, it doesn't show you're not proving that.

[00:17:42] And it has to be meaningful anything that you create, you know back to my original point of like, you could really do this on your own if you really have the time and you really have the motivation to do this, you know, more power to you but a lot of times people they, this is not why they went to PT school.

[00:17:59] They really did not go into the whole regulatory aspect of, you know what I really love writing policies or I really love reviewing HIPAA standards. The idea is that you value your time.

[00:18:10] You want actionable solutions, as opposed to just nice idea. So we actually give the tools and the resources which is so unique that has never existed where there's there's never been anything for therapy, either professional so it could be like compliance people like

[00:18:26] myself who are using this or owners. They simply could actually, you know what you want to as an example you want to expand your practice into home health. We actually give you the home health audit to say hey by the way, do you have what you need to be actually providing the service, or you need a certain waiver or

[00:18:41] consent form all these things that normally you'd be like, I'll just wing it or I'm hoping someone else will deal with it or I can't afford this or, you know, all the excuses in the book the answer is there really is no more excuse to not have exactly what you need.

[00:18:54] And that's the purpose because we've had enough of a, you know, we've had a really rough ride for the last couple years coming out of COVID and I feel like pay cuts and all the other challenges for the industry. This should not be one of them.

[00:19:08] And that was why I think we really hit it off, especially when we first met that we really want the the the profession to move forward without the baggage so to speak right we don't want people bogged down on just the nonsense we want people to say hey by the way I know what I need, and I know where to get it.

[00:19:28] And in the past you didn't really have that.

[00:19:30] So, that's why this is been a long time coming.

[00:19:35] Yeah, well, I mean, you're definitely serving a need that I think no one else wants to do. Someone's got to enjoy it. You have a passion for it. But I mean, so how do people find your services I'll put it in a show notes too.

[00:19:48] Yeah, no problem. So they can go directly to my website. It's risk and compliance analytics.com. And the whole idea is you don't want just something off the shelf. So the OIG has made it very, very clear they don't they don't look kindly on just, you know, when people tell me they took training and I'm like, Oh, how was it by

[00:20:04] I don't know. I don't remember like that it wasn't good training. You want something that's every training I've ever been through. Right, right. It's terrible. You want something that's operationally practical. And that's that's exactly where our focus is we actually give people the tools to be operationally successful, very successful.

[00:20:23] As opposed to just saying, you know what, here's another barrier. Here's another challenge. Here's another issue that you could know we actually tell you how to deal with it and how to thrive with these different challenges that that every owner has to deal with.

[00:20:34] So we're trying to really remove the hat from from whoever is dealing with all the chaos right now that they have to and it's sometimes state specific. So as you know, depending on where you are, you have either medical record rules and regulations that you have to follow that are unique.

[00:20:50] You need to know exactly what applies to you. And that's exactly what we offer.

[00:20:55] All right, well,

[00:20:57] Hopefully, you don't need the services but even if you don't currently need his services you do need his services because you don't want to need his services in the future.

[00:21:06] So I think you should definitely

[00:21:09] If you're a practice owner, or even if you're an employee who potentially like it in his story need a services hit him up all the all this information how to contact Dr. Daniel Hirsch will be in the show notes.

[00:21:21] If you enjoyed this episode make sure to give us a five star rating on Spotify and Apple special those two that helps with our SEO and our show discovery and hit that subscribe button as always you guys have a great day.

[00:21:38] Thank you.