Transcript for "What's Working: A Candid Conversation with NorCal Pain on Staff Training and Feedback": Hello, and thank you everyone for joining us today or tuning in to the session on demand. My name is John Igan, and I'm a customer success manager here at Brellium. For those of you who don't know us, Brellium is an AI powered compliance platform. We help providers across health care automatically review their documentation to ensure notes are complete and compliant with payer standards. This month, we're chatting with teams who have been innovators when it comes to quality assurance and compliance. Today, I have the pleasure to be joined by Brenda Lindenberg, CFO and COO of NorCal Pain Treatment Center. Brenda is a really fantastic champion of using data to guide organizational decisions. She's going to share how she's created a training and feedback program that's worked for her team based on data, plus other tips to really drive operational efficiency and quality. Let's dive in. Hi, Brenda. Thank you for hopping on. Good morning. Good morning. Brenda, could you tell us a little bit about your background and role at NorCal? Certainly. I am the chief financial and chief compliance officer for NorCal Payne. I've worked in health care operations, quality, and compliance for about thirty years, primarily in high risk regulatory, environments. And my role really sits at the intersection of finance, compliance, operational efficiency, and quality assurance, making sure we're delivering quality care while also building workflows that are sustainable for our providers and our staff. Great. We're here to talk primarily about training and feedback. I've heard from a lot of leaders that staff feedback is critical to retention. Do you agree with that? Absolutely. Most people generally want to do good at their jobs. They wanna do a good job. And I think it creates frustration when expectations are unclear, feedback is inconsistent. That's a big one. And staff only hear from management or leadership when something is going wrong. So consistent feedback, I believe, creates trust with staff, and it helps the staff understand what success looks like. It gives them the confidence that they're improving in in health care, especially, where the environment is stressful and heavily regulated, and people need to know that their leadership is invested in helping them succeed, not just monitoring them for mistakes. Great. In your opinion, what are the key elements to effective training and feedback? Well, there are several elements. First and foremost, it has to be timely. So feedback, you can't you can't gather data today and then report back to your staff six months from now. Your feedback has to be done timely. And secondly, it has to be done specifically. So giving someone a generalization of your documentation is poor will not help them improve. You absolutely have to give them specific examples of where the documentation could use improvement. And then thirdly, it has to be consistent. It has to be consistent across leadership. So if it's subjective, it's not consistent. There needs to be objective evidence to support the documentation improvements that you're requesting. And finally, it has to be practical. Adults do well when you direct their workflow daily. So if you can give them something that they can do every day, then it will be effective. If you're going to ask them to do it once every four months, that's not really going to be effective. You're gonna have to change how you're approaching that particular issue. Super clear. What do you think that leaders get wrong about staff feedback? I think that leaders, myself included, and I I can't say that I've never done this, we approach feedback from a punitive standpoint rather than from an improvement standpoint. So, if an interaction feels like discipline, the staff will simply stop engaging, and they become defensive. So effective feedback should feel collaborative and because the goal is improvement, not catching somebody making an error. And I think also that leaders sometimes overwhelm the staff by reviewing too many little things that need to be fixed instead of focusing on, big issues that could make a huge difference. Great. Yeah. I think that sometimes leaders don't think about compliance training specifically, or they think compliance training should only be delivered once during onboarding just, at the onset there. What do you think of that specific approach? Well, I think a few things. One, healthcare regulation changes so quickly, and it changes so frequently that annual or onboarding is not an effective way to train in our office. We we do compliance training almost on a weekly basis based on information that we're gleaning from Brelium specifically. And the the audits that we're conducting internally based on that is it's very helpful to consistently go back to providers. This is what you're missing in your coding. Go back to the medical assistance. Hey, this particular documentation isn't up to par. So, it's very helpful for them. And the thing in healthcare is that regulations change, right? Documentation expectations change. We have not new, but newer leadership in CMS currently. And what the OIG was going for is no longer what they are researching or auditing. So, those things flipped. And I got an email today that the, there are going to be some changes in the section five zero four documentation requirements, although we got an extension, but that came out of the blue. Right? So. you have to be ready and you have to make sure that your your training is part of your organizational culture, instead of a one time event. And you the best compliance education is continuous, targeted, and tied directly to the findings from our audits and the operational trends that we have been notified of. Great. As CFO and COO, and through our work together, I've seen personally, you're clearly very data oriented. How do you use data to inform your approach to training and development? Well, I will I will leave my answer with this. You cannot improve what you do not measure. So data is essential to improvement. Without data, you will not improve. Just that's the bottom line. I didn't make that quote up. I don't recall offhand who did, but that is actually a true thing, and and it just it it is absolutely true. So we try to use data to remove as much subjectivity as possible. We don't rely on opinions or isolated complaints. We look at trending. We look at recurring documentation deficiencies, modifier usage, missing elements, coding variances, workflow bottlenecks, denial patterns, audit outcomes. And all of that allows us to focus really where it will actually reduce risk and improve quality rather than creating broad education that will really will not address the issues. So it, but it also helps us identify positive trends. It's important to recognize improvement. And just give you an example, we've been tracking our coding, our provider coding inefficiencies, and I was doing it specific to each provider. I would screenshot when Brellium found an error. I would screenshot and send that to them. It helped me develop a training specific to the three top errors that I was seeing across the board over several months that didn't improve with individual screenshots and talking to the provider. So I created a PowerPoint training, and then I created an interactive quiz. I had them take the quiz before, and I had them take the quiz after. And the after, based on the information that I gleaned from the trends and was able to focus specifically on was was much improved. So it does it demonstrates that you can, in fact, focus primarily where the issue is rather than where your data is telling you the issue is rather than trying to just broadside everything and hope you knock down a couple of pins when you throw the ball. Yeah. Absolutely. And how do you think about the difference as, you're touching on how you're looking at kind of specific, microdata, you could call it. How do you think about the difference between the individual provider level, issues versus the macro trends? And and are you utilizing, Brelea in any way to identify those trends? So macro trends, we use more on the medical assistant side. We have two different we use two different question sets in Brellium. One focuses on providers, and the other, focuses on staff inside of the medical documentation and medical documentation not done by providers. So the non provider documentation is much more macro. We have about 45 questions that we, focus on there, and then we have one question for the providers. So, our trending and our our data mapping is different based on the different question sets. And it really focus in on where a specific person or a specific problem could be. But, overall, it also allows us to establish our KPIs. That's another big thing, our key process indicators. So our KPIs are established based on Brelium data that we have collected over the last year. And we know where the target should be based on what we know has been done. And when we hire a new MA, if that MA is not up to the KPI within a specific amount of time, we need to change our training because it's obviously not effective for new recruits. So there are different ways that we utilize it more macro. And then with our providers and coding, we use it very micro. Mhmm. And for readjusting your training, is that, like, on a specified schedule that you're reexamining, or is this completely based off of results that you're seeing on a regular cadence from Brelium? It's based off of results. Mhmm. So we review our results weekly, and we measure it against our required KPIs weekly. And if we identify over a period of six or more consecutive weeks that we have not, met our KPI, we consider that to be a trend, and then we address it. And we provide training. We develop a training to address it. Great. Could you dig a little deeper on obviously, you've you've been working with Brilliant for a long time now, and your team is consistently achieving very, high scores. We're talking in the high 90% pass rates. And with doing all of this, recursive review of your KPIs and of your scores, what specifically are you telling your team or or, doing to coach them to get to this very high standard? Well, the KPI is 95%, and they know the KPI is 95%. So they do strive for that. But a big part of it really was changing our workflow from being reactive to being proactive. And trending allows you to do that. Data allows you to do that. Before Brelium, our auditors spent an enormous amount of time manually reviewing charts line by line. We had a checklist that was three or four pages long, and they would have to review every single item and try to find it. And as humans, you can only do that so long before your eyes cross and you don't wanna do that job anymore. But because Brelium really identifies the documentation deficiencies for us, we we only use human review and we own for as few things as possible. So only those things that are in error in that particular chart need human review. And that that makes a big, big difference for our team because the burnout is not as real. The data overload of reviewing so again, we do about 45 questions per chart, and we do about three fifty charts a day. So if you do the math on that, the number of errors that are possible is tremendous. Humans trying to use their brain to make sure that they have addressed every single one of those errors in a timely fashion, It's just overwhelming, and the monotony of it allows for errors left and right. You you you would be amazed at how much you can make errors because your brain would just zone out. So because that's incredibly difficult to manage, Relium really, really has created efficiencies for us to focus on only the errors. Got it. Yeah. That that makes a lot of sense. And what has surprised you by tracking your documentation trends so closely? Were there any areas where you thought that staff would be stronger, where they weren't or vice versa now that we don't have to worry about, manual auditors' eyes glazing over? You know, interestingly, it is based on the employee. It's staff. Right? Where our biggest our biggest weakness is our employees. Our biggest weakness is our staff. They're also our greatest strength. But when you're talking about errors, it's very individualized. There was no one specific error that one specific employee was making with the ex that's not true. With the exception of one thing that the majority of staff misses and it's because it's just one checkbox, you You just have to check one thing. It's not a question you ask. It's just a checkbox that you have to check, and you don't get an error message from the EMR if you miss it until you go to close the church. So, we did address that one, and it is much better now, but that that that really surprised me because it's the it should be the first thing you do when you go in and arrive the patient, but they weren't doing it. But other than that, it's really individualized, and that's where the data is essential because I can find one thing with one MA. And if that MA cannot improve, we have to put that MA in a different department or replace them because everybody else can do it. Right? And I can demonstrate that everybody else can do it. That means it's an that means it's a human a human problem, not a process problem. And so you're utilizing, results across your organization to kind of benchmark what would be an acceptable expectation. Absolutely. Very and we do that very quickly. That's great. And so more specifically on that, do you use, Brelean to guide feedback, very specifically like that? So not just noticing these trends for yourself, but are you doing individualized, feedback based on the results you're seeing? You know, who needs corrective action or maybe who deserves a pat on the back for the job that they've been doing? We do. One of our the biggest advantages of Brelean, again, is objectivity. Right? So it it's not subjective. It's not an auditor reading the chart and saying, oh, yeah. And this happens. This happens a lot in life. And I'm gonna say this and you're gonna nod your head. Oh, so and so makes a lot of mistakes. Well, that is a subjective statement. What does what is a lot? Is that a lot for that person? Is that a lot comparatively? Objectively, if I can say this person has an error rate of 72% and their colleagues have an error rate of 4%, that probably needs to be addressed. Conversely, if I can say this person has a success rate of ninety eight percent and their colleagues are at ninety two percent, that deserves a pat on the back because they are excelling, they're exceeding what their colleagues are. And our expectation will always be the highest, whoever's performing the highest, because that means it can be done. But so, Brelean really allows our feedback our feedback to be much more individualized, and more importantly, it allows it to be fair and objective. Right. Against objective benchmarks that you see. across your Correct. that's great. Or subjective judgments that we see across the organization. Right. How do you see generally in in that vein? How do you see the advantages of AI, and just? technology trends in general influencing how we think about training and quality assurance in the next year or even five years? I think that if you don't get on board, it's going to cost you a lot more than you think it's going to cost you, not just monetarily. It's gonna cost you staff. It's because the staff will see they can go work somewhere else and have better results and not be potentially discriminated against because they're not learning the way they should be learning. Your training isn't designed the way it should be designed based on data trends. But in a regulatory world, it could very well cost you a lot of money in what will be recouped if you don't document correctly and you don't catch that you didn't document correctly. Mhmm. Yeah. I mean, we're definitely in a, very regulatory environment. There is a lot of scrutiny, on fraud, waste, and abuse, especially, we I feel like we've seen even more of this recently across, the health space at large, across our entire customer base even. And do you have anything that you would call out specifically to, leaders of these health organizations who are not regularly tracking their staff's documentation quality? I would say that, regulators and payers are increasingly data driven. I just read yesterday about there so there's whistleblowers, and now they're allowing AI people using AI to become a whistleblower. So CMS publishes data about physician visits and number of visits, monies paid. And you can go to their website and download that data and and look at trends and then report that to the OIG. And if the OIG decides to investigate that as potentially fraudulent and it settles, you get a portion of that money back. So in the, it used to be personal, Wow. the quid quid pro tam. It used to be that a person could report a person who worked in the environment. They just authorized that. And I just read it yesterday that now they're using AI Awesome. specifically to target practices that could potentially be committing fraud. So that is something, that I would say really ongoing monitoring inside your organization is no longer optional. It is a it's responsible government governance and risk management. And if you if you don't do it or you only do it to find problems, you don't do it for opportunities for improvement. You don't do it for continuing education or for standardization or for, operational improvements. Regulatory bodies are going to take issue with that. And being a small business or a small office is not going to protect you. I am excited. Yeah. Got it. Yeah. That's great. One thing that's been remarkable since working with you is the amount of time and resources you've saved since working with Brellium as, as we've spoken about before. How is your team reinvesting that time? Are there initiatives that you're taking on that maybe you weren't able to before? Is there bandwidth that's, suddenly opened up that you're feeling every day? Well, the biggest shift has been moving from manual detection, reviewing every single line one line at a time, to, higher quality value initiatives. So instead of spending countless hours searching for issues, they spend more time on provider education, workflow optimization, policy development, risk mitigation, which is a big one, process improvement. We've been able to extend the scope of our compliance monitoring, because the review process is so much more efficient. And, operationally, it creates just a much stronger compliance infrastructure without needing to proportionally increase our staffing resources. That's great. You've done a lot to improve efficiency on your side, since our relation working relationship started. Would love to hear from your perspective what your goals are, for the next year, what's on your to do list. While we are still focusing on improving workflow standardizations, so that we can reduce the documentation and administrative burdens on our providers. One of something very real, anybody in health care will know this, is provider burnout. That's a very, very real risk in any, medical practice. And the the the documentation requirements, the document the documentation compliance imposed by these regulatory bodies is substantial. And so if we can reduce that to our providers or for our providers by using AI, then that is what we're going to really focus on doing. So, you and I have spoken about some additional things that we're gonna do inside of our clinic. And the other thing that we're going to do is risk based monitoring. So we're going to focus more on high risk trends and use our data more intelligently, rather than doing the exact same review for every single thing. We now know where where we're a little short, and we know where we're strong. So we can really redirect our resources to those areas where we could use greater compliance without additional administrative burden on the providers. Great. I have one last question, and then we can go to some q and a from the, livestream here. If you could encourage the leaders that are listening in right now and on demand to take one step to improve quality assurance training, what would that be? That would be to make your feedback timely, objective, and actionable. So the faster your staff receives their feedback and real life examples, the faster the improvement will happen. If you wait until it becomes a major problem, then that is going to become the major problem. You need to have small, consistent corrections over time for more effective, larger corrective issue issues to be taken care of. Otherwise, it becomes systemic, and it becomes an issue to address that could potentially be overwhelming and cost you staffing. And you talk about burnout quite a bit, as well as as, as just staffing issues, when it comes to especially an intensive manual review. One of the questions from the audience today is how can we make sure our best staff feel supported? So one of the things that we have done is and this is just internal. We have a reward system where the top three producers on a specific set of errors because they're driven by job get gift cards once a month. So if you're one of the top three, if your KPI if you exceed the KPI, you have to exceed the KPI, and you're in the top three, you get a Starbucks gift card or an Amazon gift card of your choice every month. So that has been, you'd be amazed at how many people want that gift card. I don't know if it's just for the it's only $15. It's not like it's a lot of money. I don't think it's the money. I think it's the idea, the striving, right, that you want to strive and be the best in your field. And everybody sees who won those. So. right. So that that is one of the things that we do. Another one that we do is we have we use Teams. That that is our platform for communicating with each other. So we can do recognition inside of Teams. And we also have recognition inside of Paychex, which is our pay payroll platform. We have different recognition software inside of that that allows us to recognize staff. And. the what what for us, this is just internally for us and it's our culture. I have found that a call from me, a CFO or CCO, or a call from my husband, doctor Lindenberg, who is the CEO and founder of the company, just telling them they're doing a great job, that goes way beyond a gift card. Just taking the time to provide personal recognition from the top. And and we're a fairly large organization. We have about 125 employees now. So many of those employees have never met nor worked with either doctor Lindenberger or myself. So it it's a big deal when we call them and and they they know that they've been recognized by the by people who are in the top positions. And additionally, we we do go onto our teams and I will personally, or doctor Lindenberg will personally, give recognition to an employee and other employees see that and I think it matters. That's great. I do wanna really quickly ask one more from the audience, but we are running close to time. So last question here is, for those of us that aren't the CFO and COO, how do we convince CFO that training is valuable investment? Tell them to call me. Tell them to call me, and I will, I have actually done I have a study where I showed pretraining using data for training and having the data and doing the training after the fact. And our results are astronomically different in terms of retention, first and foremost, and then employee performance as a secondary to the retention. That's amazing. Well, thank you so much, Brenda, and thank you so much everyone for joining today. That is all the time we have. If anyone in the audience has any questions about how Brelemyn can help support your organization's quality assurance and training programs, please feel free to reach out. Our team is happy to walk you through how seamless compliance and quality can be. Thank Thank you again, everyone, and thanks, Brenda. Thank you so much. Have a great one. You as well.