Understand Corporate Compliance in Healthcare

In the healthcare industry, compliance is understood as the delivery of care through established guidelines. Namely, it’s the process of abiding by the legal, professional, and ethical standards in healthcare. But why is this so vital? According to Dr Paul Taheri, it’s because it enables medical professionals, as well as healthcare institutions, to build trust with patients and take greater responsibility, all of which ensures a higher standard of clinical care.

Transcript

All physicians need to examine patients and write notes. Those notes can be written in the computer and they are documented during the patient encounter. However, at the end of the encounter, their doctor must review the notes, make any necessary edits and close the note. The closure of the note is part of a compliance program that all health systems have. This is important because this is when the note is formally completed and enters into the medical record. When physicians don’t complete notes in a timely manner, the actual clinical delivery and clinical care is impacted negatively because the physicians who follow up with this patient, or deliver care at the same time, also don’t have the benefit of the physician’s earlier note. In this way, complying with what are typically required by the hospital or by the professional societies or insurance companies, impacts the clinical delivery.

The definition of compliance

So what is compliance? It is the delivery of care via established guidelines. These guidelines can be according to state and federal laws, such as related to Medicare and Medicaid, they could be policies and procedures established by professional organizations, or the parent organization such as the hospital.

In addition, compliance actually furthers professional standards and sets a higher bar for clinical care.

The importance of compliance

First and foremost, it’s important that the patients and family trust who their provider is and complying with certain rules and regulations enhances this trust.

It ensures there’s honesty, integrity, and ethical conduct in all aspects of clinical delivery. Moreover, compliance is generally an expectation of all medical professional societies and one in which all physicians are educated on.

The history of compliance

The history of compliance is complicated and longstanding. It has been developed over years through fraudulent billing practices that have been discovered at large academic teaching hospitals.

It has also been developed through, community programs, for example, the Office of Inspector General issues guidelines on compliance for all health care providers and organizations, and the health care organizations themselves create formal compliance programs. Collectively, these activities really enhance and have developed the framework for all compliance programs around the country.

The scope of a compliance program in any institution may vary. And it is the provider’s responsibility to understand the specific compliance policies and procedures at your organization. So there may be many entities involved in establishing the compliance guidelines. These could be professional societies, private organizations, federal and state functions, such as Medicare/Medicaid.

How healthcare is regulated

In general, healthcare is one of the most, if not the most regulated industry in the United States. And enforcement is very complicated. Specifically from an enforcement perspective, we have individuals within a health system who are solely committed to enhancing and enforcing the various compliance guidelines of the institution.

Outside the health system, you have insurance companies who monitor many clinical and financial activities of providers and Medicare and Medicaid also identifies improprieties in billing and coding that exist for its patient population. So there are many people monitoring compliance activities of all providers.

In conclusion, compliance is extremely important because it really sets the boundaries and standards by which all providers must deliver care. It is a uniformity across all of healthcare. And while the details may be different, it is essential that the individual provider understands the compliance rules and regulations that they are delivering care within.