Episode 39: Let’s Talk Compliance: Not All wRVU’s are Created Equal (Part 2)

In this episode, Jana Kolarik, a partner in Foley’s Health Care Practice Group, and Angie Caldwell, principal and CFO of PYA, continue their discussion on the importance of work relative value units (wRVUs) and fair market value (FMV) under the Stark Law and what this can mean for how health care organizations pay their physicians.

For more information regarding the “Let’s Talk Compliance” podcast series, please click here.

Please note that the interview copy below is not verbatim. We do our best to provide you with a summary of what is covered during the show. Thank you for your consideration, and enjoy the show!

Angie Caldwell

Hello and welcome to the Let’s Talk Compliance podcast series of Health Care Law Today, presented by Foley & Lardner and PYA. I’m your co-host, Angie Caldwell, principal with PYA.

Jana Kolarik

Hi, and I’m your other co-host, Jana Kolarik, a partner in Foley’s health care practice group. We’re excited to have you join us today. Before we begin our show, we want to remind you to subscribe to Health Care Law Today on your preferred podcast app. Please visit healthcarelawtoday.com or pyapc.com. For today’s show, Angie and I are continuing our discussion on the importance of Work Relative Value Units, or wRVUs and fair market value, which we’ll refer to as FMV under the Stark Law and what this can mean for how health care organizations pay their physicians and we’re going to focus on best practices.

Great to see you, Angie, and thanks for doing this follow-up discussion of our favorite topics.

Angie Caldwell

Always great to be here with you. Thank you.

Jana Kolarik

So in our last, this is a two-parter, so in our last discussion, we talked a lot about productivity modeling in wRVU with some recommendations related to it. We had also, just to kind of orient the audience as well, we had talked about planning issues and transparency and some of this stuff we’re going to talk about related to best practices in one of our prior podcasts, I think podcast episode 35, which was in November of 2024, time flies. So I recommend our audience, if they’re interested in a deeper dive into some of those issues, they listen back at that. But today we’re going to be talking about that best practices and some of this modeling stuff related to that.

I just want to remind folks about the Stark Law. Not that anybody really forgets that’s probably listening to this, but that is a driver of a bunch of these concerns related to FMV and the compensation modeling that we get into. So really quickly, and you know I love to wax poetic on this, Angie, but I’ll try to be quick. The Stark Law provides that a physician who has a direct or indirect financial relationship with a designated health service entity or DHS entity or who as an immediate family member with that type of relationship may not make a referral for the furnishing of that DHS for which payment otherwise may be made under Medicare unless an exception applies. Further, an entity that furnishes that DHS pursuant to that prohibited referral may not present or cause to be presented a claim or bill to Medicare or any other individual third party payer or other entity for the DHS performed pursuant to the prohibited referral again, unless an exception applies.

So this means really at its base that when a financial relationship falls under the Stark Law and a physician’s referral of the patient can’t satisfy the regulatory exception, the submission of a claim to Medicare for the service would trigger a violation of the Stark Law.

Okay. The Stark Law only applies to Medicare claims, but that’s a huge federal health care program for most of our listeners. It covers only relationships with physicians, but intent is irrelevant. So it is a strict liability statute. It’s a civil statute. There are penalties. It obviously prohibits payments based on its terms, and it also provides for civil monetary penalties, and it can lead to False Claims Act (FCA) exposure. So again, regulatory exceptions are required.

The big “two” [exceptions] that you and I talk about a lot are the bona fide employment exception and the personal services arrangement exception. So the employment exception is obviously for employed relationships and the other one is for independent contract arrangements.

Well, we’re going to focus on FMV, which is applicable to both exceptions, as is commercial reasonableness. But that FMV issue can be and is tricky for folks and maintaining or keeping track of FMV is essential throughout the entire relationship. Again, as we have said many, many times, it’s not a set it and forget it. So we don’t just talk to you, set the compensation plan and then move on with our lives. We have to ensure that it is continuing to be FMV. Some of the things that we’ve talked in the past, and we’ll talk in more detail here and I’m very interested in information from you on that, .

But let’s talk about best practices for compensation reviews. Essentially the contract is important, right? So ensuring that at its base you have a contract that on its terms is FMV at the beginning and can maintain FMV throughout the entire term of the agreement. Transparency about the terms of the agreement is important as you’re planning with physicians and as you’re planning internally and checks of FMV throughout the term of the agreement is also important. And so we’ll talk a little bit about some of that stuff.

And then the catching problematic arrangements early is important because as we’ve discussed, reconciliation or known in other terms, “clawbacks” are uncomfortable, but necessary. I mean, it should be built into contracts, the ability to do [reconciliations] to maintain FMV. But let’s talk about with all that intro, what are some best practices for annual compensation reviews?

Angie Caldwell

That was so comprehensive in a very short period of time. So kudos to you for boiling it down. So giving and feeding off of my Gen Z children, I’m going to say it’s giving FMV vibes, right? Every year is giving FMV vibes. So let’s talk about a great policy for helping an organization determine and maintain FMV for their arrangements.

First and foremost, we need to start with a well-defined policy or process. So even that at times, because within that well-defined policy and process, we have to think about the organization’s philosophy, compensation philosophy. We have to understand the organization’s risk tolerance. We have to think about volume of arrangements and the administrative burden of maintaining this policy or process. So all of that thought goes into the calculus of determining that policy.

Then within the policy and the question that PYA often gets asked, and I’m sure that you get asked this as well, Jana, is what should the thresholds be? So we have a process for reviewing, but what are my guardrails? When do I know? How do I set guardrails or thresholds for deciding if I have a problem?

And so the policy and the process should define those thresholds. And so let’s talk about those thresholds a little bit and what they should be. So sometimes we talk about them in terms of slices or perhaps we talk about this in terms of tiers. And before I go down this path, I want to caution our listeners that one test in any tier within the determination of what you do with an arrangement and whether it requires additional review or not, probably more than one test is appropriate. So you and I on prior podcasts and likely the one that you referred to from 2024, we likely talked about bright lines around the 75th percentile or perhaps the notion that everything that’s paid at median is automatically FMV. So not to say that the 75th and the 50th aren’t great thresholds for starting a review, but adding a second element to that review is likely very important.

So let’s talk about that just in a little bit more detail. So within those tiers, what a best practice would be would be to create a mechanism such that you are looking at all of your physicians either annually or in some kind of cadence, annually best practice. I have seen some every other year when the risk tolerance within the organization or perhaps comp philosophy allowed for it, but probably an annual review. And you really want to catch, and this is something you had in your opening comments, Jana, you really want to catch the horse before it’s out of the barn. And that’s why then you’re doing these reviews on an annual basis, even if the contract doesn’t have a renewal clause or an update for two or more years. So you’re looking at this every year and making sure that everything is still good, that it’s still within FMV.

So first tier maybe is you compare the compensation, work RVUs, comp per work RVU, the differential between productivity and compensation, perhaps you use the median as a starting point and if a physician meets all of those tests within tier one, nothing is required. They’ve passed the test. If they fall out of that, they don’t hit those tests, they fail one of those tests. Then perhaps the second slice is more of an internal review and documentation. And so with that then you’re looking at, well, why did they fail the test? Is it because of location? Perhaps a physician is in a rural location. Perhaps they failed the test because within the compensation plan, there’s an experience clause that puts additional compensation because of experience. Perhaps they have unique training. Perhaps there’s a need, perhaps there’s a desperate need for the physician.

Then a third tier, going down, so you hit the second tier and you’ve decided that the second tier means that you have an internal review process or perhaps after the internal review process, it still doesn’t make sense. You’re still as an organization concerned about FMV, so then you document a third and enhanced review, which perhaps increases the benchmark thresholds from the 50th to the 75th. Again, not just one, not just one 75th percentile total compensation, total cash compensation, but perhaps you’re looking at a compensation per work RVU threshold with that. You’re looking at a productivity threshold with that and you’re looking at the differential between productivity and compensation with that in addition to what you’ve already gathered in tier one and tier two.

Your slice three or your tier three, if you still are failing, the arrangement is still failing all of those tests, then they fall into that outlier category, which would at that point probably require an external review and help from someone, an external evaluator.

So with all of that in mind, just to recap, best practices, document a policy and procedure, make sure that you have the ability to follow the policy and procedure and measure on a timely basis, annual being best practice, but then also let’s think about transparency and how much then gets disclosed to the physician as it relates to these tests on an annual basis. So again, just thinking about how uncomfortable perhaps a clawback is if this is part of the process and if the process has been communicated to a physician as part of their annual education process, it’s a much easier conversation. It’s not a surprise to the physician. So Jana, helping me think about that then as a best practice related to physician education, what are some of the key takeaways or key learning objectives that should be part of a physician education?

Jana Kolarik

Yeah. And thanks Angie, that’s super helpful background and understanding really the layers that can go into this analysis for organizations I think is super important to understand. So from an education perspective and from a transparency perspective, the discussion about the Stark Law, the discussion about kickback, the foundational legal reasons for why the organization is concerned about these issues should be part of the discussion and the need for FMV should be part of it. There should be contract provisions that obviously maintain FMV as I’ve mentioned. I think they should be at the sole discretion of the employer. So that’s because there can be some debates around the edges of these issues, but foundationally as the employer, there is a responsibility and a seen responsibility by that employer to maintain compliance with FMV. So in the end, it’s got to be at the discretion of the employer as to whether something is FMV.

But those processes that you mentioned, like what are the different steps that are gone through to analyze FMV is completely appropriate to talk about and to talk and to have that transparency, for example, and we’ll get into some of this and we’ve gotten into it in the past, but if you have a component of the compensation that deals with productivity and you’re dealing with wRVUs, having those wRVUs be transparent to the physician so they understand where they stand and understand too how they are calculated. So we’ve talked in the past about modifier adjusting and so forth and so on. So all of that and that education as to how physicians are compensated is very important so that it doesn’t end up being a surprise when they get their check or surprise at the end of the year if there is an issue with FMV, it should be a dialoguing issue.

The other piece of this that I think is important is that if it is necessary to maintain FMV, that the contract allows those reconciliations. And we can talk a little bit about what this looks like from your perspective, but from my perspective, reconciling as frequently as you can is fantastic if you can do it quarterly makes sense because then you have a sense as you go through the year, annually can be challenging just because folks don’t know where they stand at various points during the year. So those are frankly things that pop immediately to mind as I’m thinking about transparency and education.

Angie Caldwell

I think too with that communication, physicians need to understand why the organization does things the way that they do. And with that understanding, and again, not to the minutia, not to the point where specific confidential matters are disclosed across arrangement types or anything like that, but the physician having a general sense as to why the organization approaches things the way that they do and that general compensation philosophy I think is really important because the physicians, as we hope that they do, have colleagues all over the country and are likely receiving information about other organizations and the way other organizations do things. And without the context of how their organization is doing things, then I think it just becomes maybe a burr in the saddle, if you will, because they just don’t understand their organization’s philosophy and approach, which is likely very much to pay the physician for their personally performed services at FMV. It is a recruiting and retention problem if the physician is not paid at FMV . And so again, it’s really to the benefit of everyone to maintain this and communicate transparently around it.

Jana Kolarik

Agreed. And I think to the point that you just made, it plays into trust. So the transparency plays into the trust that the physicians have related to what’s happening. But I also think that there’s a lot of information that floats around amongst physicians that are in different contexts and so are compensated differently because of their context. So we’ve talked in the past about the group practice and the group practice exception and compensation through the group practice. Look, if you can meet those standards under Stark and the In-Office Ancillary Services Exception, you from a group practice perspective are not concerned about FMV because you are meeting the other nine factors that go into the group practice and the other factors that go into In-Office Ancillary Services Exception. But that world is very different than the world of the employment exception and the hospital situation where we’re living with the employment exception, which must be FMV and that has some rigor around it.

Can you talk to me a little bit, because you and I have talked about people’s understanding FMV as a number. Can you talk to me about what FMV is from a valuation perspective? What does that mean in your world?

Angie Caldwell

Yes. FMV is not algorithmic. It is not a formula, it’s not a plus, minus, divide, multiply, equals one number. FMV is a range and the range is determined by a valuator, an appraiser who is taking into account all of the individual facts and circumstances that they can gather, that they can muster around the arrangement in determining that range. So benchmark data, wonderful, and we’ve probably said this on a prior podcast, benchmark data is wonderful, but it is a starting place and in and of itself does not determine FMV. It’s a starting place for those individual facts and circumstances. And within each individual element, there is a range of compensation that within an individual market makes sense. And so when an appraiser is looking at compensation, again, it is a range and then the upper end of the range is typically where individuals focus. What is the range at which if I stick a toe over, then it becomes a problem?

And the upper end of a range, I’ve got to tell you, as an appraiser, that upper end of the range is very important because it’s the range at which we buckle down and then it’s not a dollar or more unless there is a change in fact or circumstance that would drive a new analysis or perhaps an update to that analysis. In all of your appraiser opinions that you’ve probably seen, Jana, and I’ve seen a few other appraiser opinions other than PYA, we will say, you might get a different answer if you ask someone else, and that’s because FMV is in a range, it’s not algorithmic, it’s not a formula, and someone may look at something a little different. But at the end of the day, even the high end should be within a range in and of itself to match the market dynamics and the personally performed services of the physician.

Jana Kolarik

And I think a lot of this … I think we talk about complex arrangements. So we talk about highly compensated physicians and a lot of these issues with compensation and with FMV come into play with very complicated arrangements that are at play and with physicians that are highly compensated where that art that is valuation becomes important to understand or have somebody on your speed dial. So talk to me about what happens if the annual review reveals a problem from your perspective.

Angie Caldwell

Yes. And then absolutely I want to hear your perspective too because there are a lot of tentacles to this. When you find yourself in a hole, your first step is to stop digging. So when you find a problem, stop digging and make a plan. The first thing is to check your data, make sure that what you are seeing is perhaps a problem or a test failure if we refer back to the tiering and the test within the tiering. If you get to that point, first and foremost, double check your data, make sure that what you’re looking at is accurate and that you can reperform the math in a way that still reveals an issue. That’s first and foremost.

Then it’s a matter of deciding again, do you need internal or external support related to this? Part of this is {keeping} confidentiality within your committee and within your group once a problem is identified. Again, if you have the level of transparency that we are speaking about earlier with respect to physician education, when that problem is revealed, if you have that level of transparency and education, it’s an opportunity to double down and to get really serious about the data, the information, all of the facts and assumptions determining if you need external support either from someone like me, Jana, or someone like you or perhaps both when the problem takes it to that level and we’ll come back to that in just a minute.

Then too, after you get your support gathered and you determine what you need, there is an analysis {around the} need to fix the problem that caused the arrangement to be at issue so that it doesn’t repeat itself. And so that then comes back to communication, trust, contractual arrangements, and then determining if the problem is systemic. The problem could very well be isolated to one arrangement and one physician, but if there is an underlying system issue, the way work RVUs are calculated, the way the systems are looking at those, maybe there’s something else systemic that’s happening, you want to not only fix the arrangement, but you want to fix the system around the arrangement to make sure that it doesn’t happen again.

So Jana, talk to me about your perspective on this and when there is a problem, what steps should be taken? And even in the worst of scenarios, what happens when you have the worst situation and you even might have to have a disclosure, talk to me a little bit about that.

Jana Kolarik

I think it’s the internal processes, like you had mentioned, the plan that’s in place, the process that’s in place, that should save you most of the time. So if you’re midstream with a contract and you have the ability to clawback or adjust, then you can solve for FMV issues without necessitating a repayment or a self-disclosure. So I think it’s important those provisions in the contract are not intended to be punitive to anybody. They’re really intended to be safety valves for a process that is intended to keep this [arrangement] within FMV and keep everybody compliant. So I think that is the immediate sort of reaction to we might have an issue. And if you find it early enough, that can be a saving grace.

With regard to if you find it well into the process, which happens after time has passed, again, if it’s an employee there is frequently the ability or there is the ability if that person continues to be an employee to reconcile the payments that have been overpaid and get those repaid to the entity such that it isn’t an issue and there isn’t a need for a self-disclosure. So that’s the other piece of it. Even if time is passed, you’re not midstream. If there is a relationship there and an understanding of the process and the transparency that goes along with it, some of those discussions can be had and that problem can be rectified.

In the situation where the physician has left – is no longer employed – or the physician is frankly unwilling to repay the amount of money that’s been overpaid, then you’re in a situation of thinking through the self-disclosure options with regard to Centers for Medicare & Medicaid Services (CMS).

And that process is I’ve dealt with it frequently CMS is actually a good regulatory agency to deal with. The process is relatively straightforward and the settlement is typically not for the full amount of the Medicare payments, but rather a percentage, but that process in writing up the self-disclosure and making that happen and fixing the problem, as you’ve mentioned, is important because when you do file that self-disclosure, you want to make sure and you have to attest to the fact that the problem has been fixed. So if it’s the systemic issues that you’re mentioning, if it’s the calculation of the wRVUs that’s been problematic, fix that. If it’s the contract provisions that have just become problematic, fix that. So I think no matter what it is, the fixing of it is super important.

So I think from my perspective, those are the things that I would highlight. As far as bringing you in, I love to see processes that with the more straightforward compensation arrangements allow the use of surveys and the ability for organizations to handle this internally. So that there are these safety valves that you and I help them put in place, that they’re able to pull levers and ensure compliance throughout the year for most of their arrangements. It’s for those ones that are more complicated that I frequently become involved with more closely and then we’ll bring in you, someone like you as a valuation consultant to help navigate next steps with regard to compensation planning and FMV and explaining what happened if it is unclear to the organization at that point. So that from just a resources perspective is typically how it would be ideal to handle. So what are your thoughts on that?

Angie Caldwell

I couldn’t agree more. My preference is also an internal process to know, understand, find and resolve. And then really only when there is a matter that has some stickiness to it that an external evaluator or legal then gets involved because the teams, the internal teams are talented and they often have great resources and sometimes it’s just a matter of bandwidth. And so that’s another area where you and I can help, Jana. It’s just a matter of there aren’t enough hours in the day and so they need someone else just to help from a bandwidth or possibly even from a project management perspective. But really overall, I couldn’t agree with you more as to the process and how those problems need to be resolved within the arrangement. And it all comes back to, and I know we’ve said this before in other podcasts, it all comes back to the planning. If you can start out on that right foot contractually and from a communication perspective – with education that the compensation within the original contract is designed in a way to result in FMV compensation, that’s the best starting place really for all of it.

Jana Kolarik

Yeah, amen. I wonder if we want to segue a little bit into different compensation arrangements and how they fit in with the different specialties. Do we want to talk a little bit about that, about potentially problematic provider compensation elements that should just be flagged for folks to keep in mind? I know we’ve talked in the past quite a bit about hospital-based physicians and what ended up being the best practices, I guess, as compensation planning for them. And I know we had put a slide in the annual conference that we had related to that compensation structure alignment examples. Can we talk about what are things that would be maybe aligned structures and then things that may be considerations for maybe potentially not aligned structures that if possible should be avoided? Can we talk about that a little bit?

Angie Caldwell

Absolutely. So the best designed compensation plans are those that align the way the physician works and with the way they are incentivized through their compensation. So if you think about your hospital-based specialties … And I said that like it was an absolute, so let me say there’s not a one-size-fits-all, there are circumstances where different models do work, but generally speaking, for hospital-based coverage type specialties, a productivity-based work RVU model is likely misaligned in that the physician, the provider is not … They are a catcher. They are not the ones out in the market with a clinic, having the visits and the encounters outside, they are catching what comes to the facility. So they don’t have control over the volume of patients that are coming in. Now they do have control to some extent to how many patients they perhaps see in a day or perhaps throughput within an emergency room or for perhaps, or even the number of patients that they see in a hospitalist scenario.

So generally speaking, in a hospital-based specialty, a more coverage type or shift-based model is better aligned with perhaps some incentives where it makes sense. {A shift based model} doesn’t always make sense for throughput – for surge, high surge – high volume times when you know that your provider has to go above and beyond to be able to see what has come to the facility or is on the floor or is in the emergency department on that day.

On the other end of that, thinking about a proceduralist, it makes more sense for a proceduralist or a surgeon to be on a work RVU model. It is very much as you think about those different types of physicians and how each individual patient comes in, comes out, they’re in the clinic, it is very much a measure of the personal work effort of the physician and it’s less of a coverage.

Rural-based providers, I’m just going to put them in a separate category because so much of a rural provider, so much of that compensation is based upon need in the market and you might not have the volume to be able to support what is necessary from an FMV perspective for that provider, but that is just the reality at times for rural medicine. So I’ll put them in a separate category because each individual situation needs to be looked at.

In the middle are our primary care physicians. So think about family medicine, think about rheumatology, think about endocrinology, perhaps even nephrology, where you are managing a patient panel. And so in those situations, it’s almost a hybrid model that works the best. So we’re seeing a lot of movement in primary care specialties today moving to a panel-based tiered-based model with an incentive for productivity, but {productivity} is not the main calculus for the compensation.

In all of these models, Jana, I highly recommend a quality and engagement incentive simply because there are missions and needs of the employer. Especially in a hospital employed scenario, there are needs of the employer that the employer needs the physician to help drive the mission, the clinical quality, the center of excellence and all the care management and all of the things that make that facility and that system great. And so in those scenarios, that’s how you can engage with the physician to really push those mission critical elements for the hospital and health system. Have you seen anything different?

Jana Kolarik

No, but I have seen, and I think you and I have had discussions about this, I’ve seen just a push by all physicians to be paid on some type of productivity measure by wRVU, even if hospital-based. And I think the misalignment is there, but I think from a compensation perspective, I’m not sure that it benefits them. I mean, that’s the thing that I think in the end you want, as you said, the compensation that best fits the services that are being provided by that physician and frequently that model doesn’t make sense for them, even though they believe in some part of their brain that they will be paid more from a productivity perspective.

Also, I’m interested in your comments about that, but I also really want to talk a little bit, because I know we’ve talked about this in the past too, and I just want to mention it here because it is like burning a hole in my brain right now, which is quality of the data. So we talked about systems issues. And so I think you and I have had discussions over and over about we cannot emphasize enough the importance of the data that’s driving any of these factors. So just even picking up again on the wRVU calculation. So we mentioned briefly the modifier adjusting, which is part of the billing system. And I’d love for you to address that in some comments about what does that mean and how does that affect things?

I think the other thing from my perspective as a regulatory and compliance lawyer, it’s the claims accuracy. It’s the coding accuracy that plays into the accuracy of the data and therefore the accuracy of the wRVUs that are coming out of it. So ensuring that your compliance and your audit folks and everything is aligned with regard to how things are coded, my preference is if physicians want to code their work, I think it’s fine, but I do believe that a second eye on the coding and documentation is important for claims accuracy and the coding frequency that you have, again, CMS has been very clear about proactive audits being important to them and frankly important when you look at the Overpayment Rule and other things that play into that and the need to refund amounts that have been incorrectly billed, but really getting that data accurate from the get go and again, ensuring some of those levers are in place to ensure the accuracy of the claims data because it then affects the compensation data for these physicians.

But talk to me a little bit frankly about any of that. But the modifier adjustment thing I think seems to be confusing to folks. So talk to me about that a little bit.

Angie Caldwell

The data is so important, Jana, and it goes back to we are weaving a wonderful tapestry here today because we’re linking things back to the top of the podcast, but it goes back to trust, right?

Jana Kolarik

Yes.

Angie Caldwell

So if your data is not believable, then you fall back on that trust issue. And so from a valuator perspective, and I know this is not unusual to internal valuation and assessment teams as well, but you’re really looking at the data with a level of professional skepticism always when you’re reviewing it, and you can’t assume that everything is always working perfectly.

So when we were talking earlier, so weaving back to our talking about the tiers and the thresholds, another potential test, or perhaps maybe not part of the tiers, but part of the overall policy is that there should be a process to review the coding and the wRVU calculation for certain providers that fall into, maybe it’s a thing that has to be done for all of your tier three or tier two providers. That becomes part of the rotation for your internal coding and auditing team to ensure, again, that that data is as crisp as it possibly can be coming into the determination of compensation.

Because by the time that it gets to compensation, then the likelihood of there being a problem, it just gets greater. You’re more at the end of the process at that point, but if you have frequent reviews quarterly, semi-annually, if they fall into a tier, they automatically go into a bucket for one of those reviews, I really think it’s critical and part of a really good compensation planning process and compliance program. There are things from a coding perspective that can be done easily. You can look at bell curves for the physician specialty, looking at how they fall. Are they an outlier compared to their peers and then finding out why they are an outlier compared to their peers then is important.

But all of that is just absolutely critical because things can happen as system updates, as we know, as we deal with our internal systems every day, system updates and things can happen that just turn things slightly one side or another, then that makes a calculation that was reliable six months ago, perhaps not as reliable. And so it’s just always very, very, very important to make sure that all of that is clean, both from a claims perspective as well as from all of the other parts along the way where a modifier could fall off.

I had a scenario, a situation where the medical record data was transferred into a separate system and then the separate system was computing the compensation on a productivity basis. So as that happened, the modifiers were included in the first system, but then when the transfer happened over into the compensation system, the modifiers were dropped. It was a process that worked for a very long time, but then all of a sudden something changed just ever so slightly in the underlying schematics of how that data was transferred, and then all of a sudden compensation was being computed without any modifiers. And it took a minute for the organization to find it, but they found it through a process where they were looking at their data where before they were paying bonuses on a semi-annual or quarterly basis, they were looking at the data, viewed their data with professional skepticism and said, “What is happening? This trend is unbelievable. Why is it unbelievable?” So just emphasis on that matter that the data is so very important.

Jana Kolarik

Yeah, and I think to that point, looking at not having such a this point in time view of data as well, but looking holistically as you look at things and making sure that you are looking at trends and so forth, or that one of the people on your team is tracking those things because gosh knows I get into minutiae and I think you do as well, but having somebody that has that macro view of where things are going and if it doesn’t make sense, why would this have happened and digging into those details, I think always from a compliance perspective, no matter what area you’re dealing with is important. That’s so helpful. Thank you.

We have covered the things that I wanted to cover in our podcast today and the things that I wanted to make sure that we shared that we were unable to share during the annual conference. So thank you for this time and thanks for digging into some of this again with me. You know I always enjoy it. Are there any kind of final things that you just want to mention to our listeners before we say goodbye?

Angie Caldwell

I think we have also covered everything that I wanted to cover today. Jana, it is always a pleasure to be here with you and to be able to dialogue about these issues just back and forth for a podcast and even in real time in our daily work. So I really appreciate you. Thank you.

Jana Kolarik

Likewise, likewise. Thanks so much, Angie. We want to thank our listeners for joining our Let’s Talk Compliance podcast series with Health Care Law Today, your connection to timely legal updates in the health care and life sciences industry. We encourage you to subscribe to this podcast and check out our part one of this two-part series. Visit Foley’s Health Care Law Today blog at healthcarelawtoday.com and pyapc.com. If you like the show, don’t forget to subscribe and be sure to rate us five stars. Until next time, I’m Jana Kolarik of Foley & Lardner.

Angie Caldwell

And I’m Angie Caldwell with PYA. Thank you.