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Privacy, quality of care, and research are among the emerging issues that are transforming the health care compliance landscape, warn the incoming officers of the Health Care Compliance Association (HCCA) headquartered in Philadelphia. But how compliance officers can cope successfully with change in these areas will vary greatly among organizations.
Incoming HCCA president Gregory Warner, director of compliance at the Mayo Foundation in Rochester, MN, says while most compliance efforts over the last three years have focused on Medicare billing and fraud and abuse issues, other areas such as research and quality of care increasingly are becoming the responsibility of compliance officers. That means hospitals must examine the way their compliance offices are organized, he says.
Sheryl Vacca, HCCA’s new vice president, says the role of compliance officers still is evolving. "Initially, it was very difficult to know what that role was because this was new to our organizations," explains Vacca, a director at Deloitte & Touche in Sacramento, CA. Today, it is difficult because of the growing list of responsibilities such as privacy and quality-of-care investigations.
According to Michael Hemsley, HCCA’s second vice president, the emergence of thpse multiple responsibilities means the role of compliance officer increasingly involves coordination and consultation as much as oversight. In fact, he says compliance officers who attempt to run all these tasks directly out of the compliance office on their own do so at their own peril.
"The government is throwing a wider net, and compliance officers must have a broader view of the organization’s responsibilities," Hemsley says. "It is going to be largely a matter of coordinating more diverse groups within the organization because it is far more than one person can handle."
But moving responsibility and accountability beyond "the compliance suite" is no easy task, he warns. For one thing, compliance officers must maintain their role as leader and spokesperson for compliance within the organization even as compliance migrates into operations, adds Hemsley, who also is vice president of corporate compliance and legal services for Catholic Health East in Newton Square, PA.
According to Hemsley, managing the new privacy requirements mandated by HIPAA is only the latest example of expanding responsibilities. The same is true in the area of risk as the government extends its reach beyond billing and coding to other areas that implicate federal dollars. "The government has gone beyond billing," he asserts. "Now compliance needs to go beyond billing, although that is obviously still the highest-risk area."
Hemsley points out enforcement officials now are looking for patterns of problems with patients that deal with areas such as nutrition, nursing care, and staffing levels. "The question is whether the organization is identifying those problems, assessing the causes, and taking some remedial measures," he says.
But while that may be the only way to prevent these problems from becoming fodder for False Claims Act allegations, Hemsley says compliance officers must be careful not to try to manage that entire area alone.
Vacca warns it is no longer just the federal government but increasingly state and local agencies that now are scrutinizing hospitals. In addition, the Joint Commission for Accreditation of Healthcare Organizations (JCAHO) now is emphasizing patient safety standards.
While JCAHO always has played some role in this area, it is now formalizing that role and emphasizing performance improvement, outcomes measurement, and data analysis, Vacca reports. "I would not be surprised if some of these parties do not start working in more of a collegial fashion to identify the deficits in our industry," she adds.
The Joint Commission is getting mostly positive reviews on its recently approved standards focused on patient safety and medical error reduction in hospitals. But experts warn that integrating these new standards into existing safety protocols will be no easy task.
The new standards augment the nearly 50% of current Joint Commission standards related directly to patient safety. Requirements for establishing ongoing patient safety programs in organizations accredited under the Comprehensive Accreditation Manual for Hospitals will be added in the areas of leadership, management of information, and other functions. The anticipated implementation date for the standards is July 2001.