Healthcare Compliance? How Do I Know?

 

Healthcare Compliance is mandatory, but also so confusing. Providers today seem stuck with one of two choices; first, ignore compliance, or do as little training as possible in hopes of staying out of trouble, or second, dedicate enormous amounts of money and time to stay current. There doesn't seem to be a third choice out there for providers to have their staff trained in current regulations, and not have to spend thousands of dollars to accomplish this. The following tips will allow you to realize there is another choice.

For the better part of my career, I've been working almost exclusively in healthcare compliance and government regulations where I've taken thousands of calls from healthcare professionals with different compliance related questions. The calls come from every state and from nearly every specialty. Some of my favorite’s questions include: "Do we need to burn used needles in the back-parking lot?" "Can HIPAA give a fine to my employee for smoking?" "Is it OK for me to draw my own blood?" Some of the questions were shocking and others just made me laugh, however, the most common question I receive is: "How do I know when I am compliant?" I've learned that what providers and their staff are really asking is "How do I know when I've done enough to avoid an audit or survive one it when it happens?"

Years of observation have taught me that a majority of those working in healthcare today view compliance as something to check off your list, or finish. If you view compliance this way, you've set yourself up for frustration. This frustration usually leads to ignoring or disregarding compliance, then mistakes, followed by audits and fines. Ignoring compliance will cost you. Some providers disregard compliance thinking that because some training took place years ago, they are still protected. Even if you took a couple of minutes to train a new hire, DO NOT make the mistake of thinking past training equals protection today - Healthcare Compliance Program.

Three major events usually trigger an audit. They are: injuries, state specific crackdowns, and complaints. Complaints are by far the audit-triggering leader, with the majority of complaints coming from your own employees. Training must remain current, and occur at least every year, especially if you have high turnover. A disgruntled employee is the best candidate to file a complaint against you.

The reality is you're never done when it comes to compliance, BUT you can reach a point where you can be confident you've done enough to avoid most audits and survive one if it came to your way. Those who pay no attention to compliance because they have never been audited are typically the ones who receive the largest fines. To feel confident, you must establish a "foundation for protection."

Whenever I get a call about a very detailed or complex compliance issue, I first try to determine what kind of foundation is in place. I do this because if the foundation isn't in place, you have bigger problems than getting the answer to a complex question. This doesn't mean you should ignore complex details that surround compliance- they can get you into trouble, but rather pay attention to them AFTER your foundation is in place. You wouldn't install a stained-glass window onto a home before the foundation was secure. Here are three steps to help you determine if you have a secure foundation.