Positive Physicians : Keys to an Effective Compliance Program

This is a subtitle for your new post

Successful risk avoidance strategies will be a little different for every medical organization. No two are the same. But every set of solutions is given its basic shape by the laws that govern the healthcare industry, and compliance with those laws is the mark of a mature medical practice that values its security and its patients' safety.

Modern healthcare regulations are incredibly complex, and many providers have struggled to keep up with the change. Now, in the post-COVID-19 era, major changes are happening daily and it is critical that you and your organization stay focused on adherence.

The Department of Health and Human Services, Office of the Inspector General (OIG), has outlined seven steps that every organization can take to ensure their compliance. So, whether you are just getting started, or looking to improve your current compliance program, these are excellent guidelines to follow.

1 - Establish Your Policies

The word 'policy' encompasses a few different things. A 'policy statement' is a declaration of your intentions and goals, without setting any actual, concrete 'policy.' The policy statement guides the creation of procedure and guidelines.

A 'protocol' (or 'procedure') is a set of specific actions that your organization expects to be taken in specific situations. Violating a procedure may result in disciplinary action.

A 'guideline' outlines recommended but non-mandatory actions or considerations.

All policies should be written out and easily accessible for any employee.

2 - Choose Your Compliance Leadership

A Chief Compliance Officer (CCO) must be appointed. A CCO is, ideally, a person who displays leadership qualities; inspiring confidence in others with a clear vision of where they are taking the organization. This is a top-level position and they will work directly with your board of directors, legal counsel, and the rest of the hospital's administration.

The OIG also recommends that a compliance committee be established to advise the CCO and assist in the implementation of the compliance program. This committee should be representative of organization i.e. operations, finance, audit, HR, utilization review, etc. and the CCO is considered the chairman of the committee.

Some of the committee's responsibilities will be:

• Analyzing the organization's industry environment and legal requirements
• Assessing existing policies and procedure that address these areas for possible incorporation into the compliance program
• Working within their own department as appropriate to develop standards of conduct, policies and procedure that promote compliance

Most compliance committees tend to meet quarterly, but there should also be a contingency for meeting monthly or at short notice if any urgent situations need to be addressed.

3 - Bring Everyone Up to Speed

Education and training for all employees is important so that they are aware of the policies, the expectations of the compliance program and other liability concerns like fraud or abuse laws. It is important to remember that compliance programs are aimed at not just ensuring patient safety but also Occupational Safety and Health Administration (OSHA) requirements, Clinical Laboratory Improvement Amendments of 1998 (CLIA) regulations, the Employee Retirement Income Security Act requirements, etc.

4 - Make Communication as Easy as Possible

The compliance program should offer many routes for employees to submit concerns or report violations, anonymously if necessary. The committee must take all reports seriously and follow a procedure to investigate and rule on them. Solving the problem in-house is always the preferred outcome. An employee whose concerns are ignored may end up going directly to the OIG as a whistleblower.

5 - Routinely Check the Process

The committee should constantly monitor how their compliance program is functioning and routinely audit different departments to ensure compliance. They will ensure that reports are being addressed, and, when violations happen, there are disciplinary actions, or steps to re-train the at-fault employees.

6 - Make the Disciplinary Parts of Your Policy Clear

The written policies of the compliance committee must be explicit in disciplinary consequences of violating those policies. Working with HR and the legal counsel to ensure that these consequences are being enforced.

7 - Be Vigilant in Supporting the Policy

The safety of the organization relies on promptly and seriously responding to violations or potential problems. Foreseeing a problem and correcting it is obviously better than cleaning up after the organization has been exposed.

We Can Help

If you have any questions about starting a compliance program at your organization or

questions about your existing program, Positive Physicians is always ready to help

answer them. Just contact us and we will reach out to help.