There are many valid reasons why the health care industry is regulated. Providers are obligated to provide the best possible health care, and part of that objective is to have an effective compliance program that ensures quality care from physicians, nurses, support staff, as well as administrators and executives. It helps ensure proper medical care and accurate billing. Because the health care system is so large and complex, it is easy to make mistakes or perhaps be tempted to cut corners or bill for unnecessary treatments or services not rendered.
A few bad apples do not reflect the state of health care in the U.S. So, health care systems should look at inquiries and investigations as an opportunity to highlight the quality of care offered to patients. If these actions do find errors or oversights, the organization can address the issue to improve the care it provides.
Communication and resolution in New York
Five New York City hospitals successfully implemented a communication and resolution program to improve the quality of care and response when staff did not meet acceptable standards. The program’s goals were:
- Improve the reporting of serious events to risk management
- Quickly investigate why the injuries occurred
- Communicate the results to patients
- Offer apologies and compensation when they didn’t meet their standards of care
All five hospitals’ standards of care improved over 22 months. This success was due to strong support from hospital leadership and insurers and adequate staffing.
Providers can set up their own programs
Health care providers here in Washington face different challenges than those in NYC. Nevertheless, the new system focusing on accountability and compliance is still applicable. Rather than take a defensive posture, health care providers can set up similar best practices for addressing investigations and inquiries. It can help highlight the shortcomings of a system and ideally reduce the risk of medical malpractice claims.
The new initiatives to improve an organization’s compliance program can include:
- Written P&P
- Audits
- Response
- Training
- Ongoing monitoring
Non-compliance is a big mistake
There is a long list of costly mistakes for providers who do not take these compliance issues seriously. There will be financial penalties, damage to the provider’s reputation, additional governmental oversight, loss of Medicare and Medicaid, and even criminal charges.