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Why Medical Compliance Programs Fail & How to Fix Them

Medical practices, or any type of company and business venture for that matter, often spend considerable time, effort, and money on developing plans to ensure regulatory compliance and reduce their exposure to violations, liability, and adverse repercussions. Many practices, however, fall short in achieving that objective – sometimes with devastating consequences.

When it comes to industries as highly regulated as health care, the fact that medical practices are vulnerable to a range of misconduct and subject to intense scrutiny in matters involving waste, health care fraud, and abuse makes the task of ensuring regulatory compliance immensely difficult, as well as the task of gauging the effectiveness of any compliance program currently in place. Even when practices believe they have taken steps to create compliance efforts for anything from training and systems intended to prevent and detect violations, it is often the case that they have underestimated or improperly assessed the effectiveness of their compliance programs.

When it comes to assessing the effectiveness of your medical compliance program, there are a few common pitfalls to avoid. These include:

  • Incomplete metrics – Evaluating a compliance program should be done comprehensively. That’s especially true when it comes to holding individuals accountable for compliance and assessing effectiveness through incomplete metrics. For example, many practices make the mistake of demonstrating accountability using statistics that don’t fully indicate whether they truly hold all employees accountable. This means there is a need to gather metrics on situations when employees are not disciplined, as a practice which disciplines 5 employees in a year because 5 employees failed to meet compliance terms that year is far different from a practice that disciplines 5 employees out of 50 who violated compliance policies, or one that disciplines lower lever employees and protects those who earn the practice more.
  • Invalid metrics – Because there may be a range of data collected on compliance programs, assessing effectiveness begins with looking at the right metrics. This is due to the fact that certain statistics do not always correlate with the impact of a compliance program. For example, some practices may focus on the numbers of employees who obtain compliance training, or the amount of hours training is held. These are not a meaning measure of effectiveness. Instead, practices should focus on outcomes directly tied to those efforts, such as changes in employee conduct, reductions in compliance violations, the use of acquired skills in addressing anticipated situations, and a general demonstration of policies and procedures.
  • Mistaking legal accountability for program effectiveness – Compliance programs can have important legal functions, but a focus on legal accountability can impact any positive influence on employee behavior. While having practice employees sign statements for reading and understanding policies can provide legal grounds for disciplinary action or termination, it does little to ensure employees will effectively apply those policies to their day-to-day work. Instead of focusing on accountability in legal terms, practices should focus on ensuring their employees understand and implement policies with structured training programs or a culture that focuses on why compliance programs are in place, easy to understand terms, and actual outcomes.
  • Bias in self-reporting – Surveys are an important part of assessing a compliance program’s effectiveness, but the results of such self-reporting can be subject to bias that compromises a true and accurate reflection of how compliance plans actually perform. Additionally, compliance managers may also draw incorrect conclusions about feedback provided from employees, particularly if most employees are generally reluctant to voice concerns and only a few of the same employees do, or when those in senior positions or those who do engage in violations are less inclined to participate or provide honest feedback. This bias needs to be accounted for when interpreting metrics, and tempered by data collected through less biased means, such as metrics on the actual impact of a compliance program.

How We Help Medical Practices Ensure Compliance

At Hendershot, Cannon & Hisey, P.C., our experience in health and medical law, business law, and the numerous issues practices and companies face when it comes to compliance – including issues involving violations that have already occurred and resulted in allegations of waste, fraud, or abuse – enables our firm to help all types of medical practices create and implement proactive plans and policies for ensuring regulatory compliance.

One of the major issues we find when working with medical practices is the need tolink compliance efforts to objectives, including the main goals of preventing misconduct and violations, detecting violations when they occur, and aligning practice policies with applicable laws and regulations – of which there are many in the health care industry. These goals should be linked to every component of a compliance program.

While we tailor our work to the unique situations and needs of our clients, when setting up a medical practice or working with established practices, we also look at a few important components inherent to effective compliance. These include:

  • Do you have a qualified person assigned as the compliance officer? The most effective compliance programs take the next step and put an entire committee in place to act as checks and balances and to ensure that input is gathered from a cross section of your departments.
  • Do you have an effective and efficient records department? Compliance is as much about tracking what happened in the past as it is about preventing problems in the future. We will show you how to set up an effective records department that will meet program needs.
  • What are you doing about ongoing training and education? It is not enough to set up a compliance program and walk away. Regulations and laws change. Hendershot, Cannon & Hisey offers knowledgeable legal advice about how your staff can stay trained as laws change.
  • Are your employees held accountable for compliance? The best-run compliance programs include performance objectives for staff. We can show you some effective, attainable compliance performance goals that tie in neatly with current job responsibilities.
  • Are you effectively monitoring and auditing your compliance program? As regulations change, you will need to be able to show that your facility reacted quickly and accurately. We offer a full range of compliance audit services that let you concentrate on providing health care services.

If you have questions about ensuring regulatory compliance as a medical practice, or any issues involving health care and medical law, our legal team at Hendershot, Cannon & Hisey, P.C. is here to help. Our Houston health care lawyers have earned national recognition for our work in this field, and are prepared to leverage our 130+ years of collective experience to assist your practice in creating and implementing an effective compliance program that best fits your unique needs and objectives. To speak with an attorney, call (713) 909-7323 or contact us online today.

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