Healthcare Business News
 
Aubrey Andrews
Aubrey Andrews

The future of healthcare: Regulation and compliance

Delivering high quality: Compliance programs will need to withstand post-reform challenges


By Audrey Andrews
Posted: July 25, 2011 - 12:01 am ET
Tags:

Will compliance programs survive into the next decade? Will they help us navigate healthcare reform? Or will they sink to the bottom of the ocean: too expensive, too distracting and too hard to measure?

The easy answer is that compliance programs will be thriving because they will be mandatory.

And boards and management teams will decide that the fines are too high and the reputational risk is too great not to have them.

But a more honest answer may be that nothing should survive in a post-reform environment if it doesn't deliver high quality for low cost. Like everything in healthcare, compliance programs need to prove their value if they are going to last.

Advertisement | View Media Kit

 

More than a shield

Part of the challenge is that many compliance programs were installed as a shield to protect against the government investigations of the 1990s.

Like home security systems, they deterred crime and were essential on the rare day when an intruder entered. But the compliance programs of the future will be expected to help deliver better patient care, bend the cost curve, improve employee engagement, protect the organization's reputation and, most important, solve problems that cut across the silos of healthcare.

There are several qualities I believe we will see in future compliance programs:

Support of mission and values: Effective organizations use their mission and values to guide their strategy and decisions. Compliance programs of the future will flow from the organization's mission and values rather than flowing from the minimum standards set by laws and regulations. “Rules-based” compliance programs do not resonate with employees over the long term. Values-based compliance programs weave themselves into the fabric of the organization and become part of its culture.

Independence: The ability to honestly evaluate weaknesses is critical to achieving excellence. Organizations that welcome this self-analysis will have high degrees of independence on their boards and in their compliance programs. Independence provides a fresh perspective and promotes the frank discussions that are necessary to create leaps in improvement.

Clear scope: Compliance programs will heavily invest in identifying the top risks to the organization and will let go of the small risks. At Tenet Healthcare Corp., we consider healthcare to be “compliant” if it meets quality standards; is medically necessary; is provided by qualified physicians and staff; is provided without financial incentives; is provided in an approved facility; promotes patient rights; is reimbursed correctly; and is documented, charged and billed correctly. We have developed extensive internal tracking systems, measurements, audits and reports that are divided into these eight areas so that we can easily spot trends and address them.

Business focus: Compliance programs will operate more like a business unit and less like a response team. They will set targets, gather objective data, measure performance, tie compensation to achievement of targets and be more accountable to the organization. Compliance programs that establish compliance targets and demonstrate their performance will succeed over those that focus only on prevention and response.

Employee engagement: As a service industry, we strive to hire the very best people. And the very best people want to work for values-driven organizations that do the right thing. They desire to be in environments where improvement and innovation are fostered and where managers are open to new and better ways of doing things. An organization's compliance program can be a very effective recruitment and retention tool if it focuses on values rather than rules. Effective compliance programs will connect policies to their values rather than teaching employees to follow them because it is mandatory.

Collaboration: Compliance programs of the future will be more collaborative. We will move beyond the idea that billing or quality or law is the responsibility of one leader or provider. Compliance programs will be accountable to the organization for solving problems that cross multiple areas and will work collaboratively with others—inside and outside their organization—to get it done.

Credibility: Compliance officers will no longer be viewed as police officers who are there to write tickets. Organizations will not ask: “Why do I need a compliance officer?” any more than they would ask: “Why do I need a chief financial officer?” As compliance officers become valued members of the leadership team, they will earn this level of credibility.

Real change: The true test of a compliance program is whether it can lead real change when change is needed. A good compliance officer knows when big changes are needed and will dedicate the time and energy to move the culture. They will identify the need for change before receiving a subpoena from the government, and they will effectively engage other leaders in making that change.

In the coming decade, effective compliance programs will be an essential element of all healthcare businesses. But they will not be essential because they are mandatory. They will be essential because they are worth the investment.

Audrey Andrews is chief compliance officer for Tenet Healthcare Corp.


More than a shield

Part of the challenge is that many compliance programs were installed as a shield to protect against the government investigations of the 1990s.

Like home security systems, they deterred crime and were essential on the rare day when an intruder entered. But the compliance programs of the future will be expected to help deliver better patient care, bend the cost curve, improve employee engagement, protect the organization's reputation and, most important, solve problems that cut across the silos of healthcare.

There are several qualities I believe we will see in future compliance programs:

Support of mission and values: Effective organizations use their mission and values to guide their strategy and decisions. Compliance programs of the future will flow from the organization's mission and values rather than flowing from the minimum standards set by laws and regulations. “Rules-based” compliance programs do not resonate with employees over the long term. Values-based compliance programs weave themselves into the fabric of the organization and become part of its culture.

Independence: The ability to honestly evaluate weaknesses is critical to achieving excellence. Organizations that welcome this self-analysis will have high degrees of independence on their boards and in their compliance programs. Independence provides a fresh perspective and promotes the frank discussions that are necessary to create leaps in improvement.

Clear scope: Compliance programs will heavily invest in identifying the top risks to the organization and will let go of the small risks. At Tenet Healthcare Corp., we consider healthcare to be “compliant” if it meets quality standards; is medically necessary; is provided by qualified physicians and staff; is provided without financial incentives; is provided in an approved facility; promotes patient rights; is reimbursed correctly; and is documented, charged and billed correctly. We have developed extensive internal tracking systems, measurements, audits and reports that are divided into these eight areas so that we can easily spot trends and address them.

Business focus: Compliance programs will operate more like a business unit and less like a response team. They will set targets, gather objective data, measure performance, tie compensation to achievement of targets and be more accountable to the organization. Compliance programs that establish compliance targets and demonstrate their performance will succeed over those that focus only on prevention and response.

Employee engagement: As a service industry, we strive to hire the very best people. And the very best people want to work for values-driven organizations that do the right thing. They desire to be in environments where improvement and innovation are fostered and where managers are open to new and better ways of doing things. An organization's compliance program can be a very effective recruitment and retention tool if it focuses on values rather than rules. Effective compliance programs will connect policies to their values rather than teaching employees to follow them because it is mandatory.

Collaboration: Compliance programs of the future will be more collaborative. We will move beyond the idea that billing or quality or law is the responsibility of one leader or provider. Compliance programs will be accountable to the organization for solving problems that cross multiple areas and will work collaboratively with others—inside and outside their organization—to get it done.

Credibility: Compliance officers will no longer be viewed as police officers who are there to write tickets. Organizations will not ask: “Why do I need a compliance officer?” any more than they would ask: “Why do I need a chief financial officer?” As compliance officers become valued members of the leadership team, they will earn this level of credibility.

Real change: The true test of a compliance program is whether it can lead real change when change is needed. A good compliance officer knows when big changes are needed and will dedicate the time and energy to move the culture. They will identify the need for change before receiving a subpoena from the government, and they will effectively engage other leaders in making that change.

In the coming decade, effective compliance programs will be an essential element of all healthcare businesses. But they will not be essential because they are mandatory. They will be essential because they are worth the investment.

Audrey Andrews is chief compliance officer for Tenet Healthcare Corp.



What do you think?

Share your opinion. Send a letter to the Editor or Post a comment below.

Post a comment

Loading Comments Loading comments...

Search ModernHealthcare.com:


 

Switch to the new Modern Healthcare Daily News app

For the best experience of ModernHealthcare.com on your iPad, switch to the new Modern Healthcare app — it's optimized for your device but there is no need to download.