Do You Really Know What You Are Missing? How An Effective Compliance Program Tailored To Your Practice Can Make All The Difference

March 26, 2021   |   CM&F Group   |   In Healthcare Professional

Practice owners operating successful businesses across the country share many positive attributes, but when it comes to treating patients, demonstrating functional outcomes and overall customer satisfaction there is no exact recipe in a cookbook to follow. When the topic of compliance is brought up to practice owners, the common reflex is often a defensive comment about why it is just not a top priority at this moment.

There never really is a fantastic moment to speak about compliance and what each business needs to be doing right now in order to prevent, reduce and mitigate risks. Every owner makes important decisions each day regarding return on investments, growth opportunities and long-term goals; however, nothing is more important to the health of your company than making sure you are protecting your investment. A proven method to protect your practice from “unforeseen” occurrences is to transfer liability and risks using the insurance property and casualty products provided here (e.g., general, professional, and cyber).

Facts About Compliance Programs

Healthcare organizations are required to have an effective compliance program since the passage of section 6401 of the Patient Protection and Affordable Care Act of 2010. The Office of Inspector General of the U.S. Department of Health and Human Services outlines what compliance programs should include and makes recommendations on how to design them according to your available resources. The Office of Civil Rights at the U.S. Department of Health and Human Services issues guidance on how to safeguard HIPAA standards, but ultimately each practice needs to make the critical and smart decision of having a formal compliance program.

How to Implement & Maintain a Meaningful Compliance Program

The general list below highlights elements of what each practice should have in place as part of implementing and maintaining (on an annual basis) a meaningful compliance program. Again, each owner needs to decide how to, practically, achieve these objectives:

  • Implementing written Policies, Procedures and Standards of Conduct
  • Designating a Compliance Officer
  • Conducting Effective Training and Education
  • Developing Effective Lines of Communication
  • Conducting Internal Auditing and Monitoring
  • Enforcing Standards of Conduct through “Well-Publicized Disciplinary Guidelines”
  • Detecting Offenses and Responding with Corrective Action

Before you start thinking about how difficult or overwhelming all of this sounds, first let us mention what the benefits of having an effective compliance program really are. Having great insurance doesn’t mean you want to be in a situation which requires you to use it. A practice can minimize its exposure to risk and the likelihood of reporting an insurance liability claim by the proven practice of maintaining a comprehensive compliance program. Regardless of the size of your company, enforcement fines and penalties are reduced in cases where a company can prove an effective compliance program was in place. Additionally, establishing a culture of compliance in the healthcare workplace is critical and influences every single employee. Each of us has an obligation to help fight and stop the fraud, waste and abuse seen in the healthcare industry. Being proactive by creating or implementing an effective compliance program is not just a requirement, but helps improve the efficiency, safety and quality of our skilled services. As Benjamin Franklin once said, “an ounce of prevention is worth a pound of cure.”

Remember, federal agencies have changed course over just the last few years and now stress the importance of workforce education and regulatory awareness (rather than simply penalizing non-compliant providers) by encouraging practices to make well-informed and company-appropriate operational decisions.  We all demonstrate some form of bias when performing self-assessments, but you can ensure the success of your business operations through a well-designed compliance program; then it will be possible for you to truly know if your operations are as good as you originally thought.

Daniel Hirsch, PT, DPT, CHA, OHCC

A graduate from Towson University with a B.S. degree in Exercise Physiology in 2004 and a DPT from Drexel University in 2010. Daniel has clinical experience in the acute, subacute and outpatient settings and is currently the Director of Compliance and Internal Audit for a large multi-state outpatient therapy provider. He has over 10 years of experience in risk management and has created a comprehensive compliance program which includes teaching compliance to staff members through role-based annual training.  Daniel is both a Certified Healthcare Auditor and Officer of Healthcare Compliance Certification through the American Institute of Healthcare Compliance.

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