Contrary to popular belief ‘compliance’ is not a four letter word. The stakes are too high. We have all taken the required compliance modules. We know that the federal government has taken laws written during the civil war to address fraudulent war material and applies them to medical care. We know they recover billions of dollars a year by focusing on hospital documentation that doesn’t meet the federal requirements. Care that isn’t documented properly won’t be paid for properly either. Improper release of medical information has led to dismissal from jobs and heavy fines for institutions. Researchers that don’t follow billing regulations carefully can have their grants recalled and programs closed.
It doesn’t end there, of course. Over 45 federal agencies write laws regulating some aspect of healthcare, from the use of credit cards to reimbursement for abortions. Agencies carrying the imprimatur of the government, like The Joint Commission are in a position to deny hospitals payment for federal and state services for failure to meet their requirements. Most laws governing health care are written at the State level, adding more to our regulatory burden.
Since ignorance of the laws is no excuse, UI Health has a responsibility to assure that we are trained appropriately not ‘merely’ to our health care tasks, but to the rules and regulations as well. Hence, we take ethics courses, and fire safety courses, and material safety courses, and you know the rest.
The Federal Government has laid out several elements to assure good compliance practices:
1. Establishment of appropriate Policies and Procedures
2. Development of Educational and Training Programs to keep employees apprised of their responsibilities
3. Development of open lines of communication to provide feedback and assist improvement of our business and care processes
4. Establishment of monitoring and audit programs to assure the processes are conducted properly
5. And finally to detect ‘offenses,’ develop corrective plans, and enforce disciplinary standards.
We are most often deficient at step 2. We don’t onboard our employees efficiently nor do we educate them well to these changing requirements. As an educational institution, we don’t fully prepare our students for this new regulatory world. This educational gap gives us an early target for improvement, and one for which the Institution is already hard at work.
The rewards for those of us in health care remain the same as they have for many years–the opportunities to establish close, gratifying relationships with people as we work to improve their quality of life. Just as we have worked to hone our professional skills, we’ll need to be properly aware of the milieu in which those skills are utilized, one often beyond our control. Health care structure is changing, regulatory controls will evolve at an increasing pace. We’ll have to be alert, sensitive and compliant in order to provide great care and continue to do the things we love to do.
We look forward to working with you, to be as minimally intrusive as possible, but to help guide everyone through the morass of applicable rules. Working together we can provide a safer environment for both our patients and ourselves. Enjoy this newsletter, and learn from it.
Dr. William Chamberlin