An Approach to Compliance

Compliance is a complex subject. Perhaps the most difficult to master in Health Care Management, if it ever can be mastered. We brought in compliance across our organization almost 12 years ago to ensure appropriate documentation, proper coding, and billing, adherence to federal and state statutes, ensuring employee and patient safety, and creating an equal opportunity work environment for all. I can say with confidence that we have come a long way since we started. A culture of compliance has been created. And yet, every day we find new problems and new issues that missed our ken.

If I could describe the whole gamut of compliance in one word, it would be ‘integrity’. The integrity of systems, of people, of processes, of thought, of feeling, of behavior and etiquette, of everything that we do, day in and day out. It starts with creating an atmosphere where doing the right thing is always accepted, nay applauded. Where the only fear is of hiding one’s mistakes. This integrity is not only on the individual but at an organizational level as well. Creating a culture of compliance and enforcing it, drilling it into our DNA is a constant process. The eventual goal is that it should become natural and reflexive behavior.

How does one create a culture and an organization of compliance? How do we create a culture where the benchmark is openness and honesty and errors are fixed as soon as they are recognized without any attempt at concealing? To my mind, it starts from the top, the leadership. Those at the helm of the organization have to accept it whole-heartedly and live it, no matter the cost. It is only then, that it can flow down the rungs of the company.

The other most critical part of this transformation would be to hire a strong compliance officer, someone with experience in the field, with native intelligence, passion, and willingness to learn constantly. Someone strong enough to stand up to errant folk but also someone who can empathize and explain arcane matters in an easy to understand manner. Someone who is relatively independent and yet focused on the whole team and its attempt to excel.

Eventually, the compliance officer (CO) needs to be free of the constraints of the normal hierarchy of the organization. He or she should report directly to the Board of Directors and the Chief Executive Officer and not to anyone else. This would allow for the CO’s autonomy and ability to give direct and unadulterated feedback at the highest level.

The culture of the organization also has to be focused on learning and knowledge-sharing. Regulations are changing constantly and the key decision-makers in the organization need to be aware of the changes. Compliance is sufficiently vast and complex to expect a hundred percent mastery over the subject in the company. The only way this problem can be addressed is to hire the best consultants in the business and ensure that there is constant learning among all echelons of the leadership.

Proper systems and processes are needed. Continuous training and reviews of all personnel are the sine qua non. Reporting and data collection have to be real-time and regular. Transparency of business intelligence and cognitive technology should be developed.

A strong compliance program will deal with a variety of issues, including federal and state statutes, employee and occupational laws, medical and legal concerns, and risk management and communication issues. The organization has no choice but to become proficient in handling any issues that may come up daily. Not following the standard operating procedures is dangerous and should be completely avoided.

A robust compliance program is a long-term investment, trading short-term pain for long-term safety and success. It takes tremendous resources and effort to develop and many years in the making. A predictive, proactive, and preventive mindset is of utmost importance and constant vigil and willingness to comply are the pillars of its proper execution.