Trends in Healthcare Compliance

FREMONT, CA: The minefield of rules and regulations is hindering the implementation of emerging technology in healthcare. The rise in cyberattacks and growing concerns over data privacy has resulted in the roll-out of laws that have limited the capabilities of the healthcare sector.  To escape the shackles of regulations, it has become imperative for organizations to invest in healthcare compliance.

The SAI Global Healthcare Compliance Report states that 20 percent of healthcare organizations have a single full-time professional handling compliance, and almost 13 percent have hired a part-time professional to manage the task. The negligence toward healthcare compliance is as blatant as the paltry budget dedicated to the sector. In this regard, many healthcare consultant companies are offering robust solutions to assist the organizations in auditing their compliance with the regulations. Organizations can leverage the solutions to audit the compliance of their processes and avoid government penalties.

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Compliance Investment

According to a 2018 SAI survey, almost 50 percent of compliance officers employed by various healthcare organizations expect their budgets to remain stagnant. Around 25 percent expect to see a rise in investment, whereas 10 percent of the respondents expect a decrease in budget. To comply with government regulations, it is essential for organizations to increase their investment and accommodate the responsibilities of the compliance unit. As much as 85 percent of the organizations have an executive compliance committee comprising of key executives, and often, even the CEO. Sometimes, legal counsel and human resources are also included in the committee. The office of inspector general (OIG) and the department of justice (DOJ) require the executives to be responsible for the compliance program, the failure of which may attract adverse retributions from the government.

In this regard, organizations can leverage data analytics and deep learning to draw insights from the troves of past data. The actionable insights can aid the executive committee in forming efficient budget plans. The predictive analytics can also help the committee in predicting the needs of the compliance unit.

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 Compliance Management

Organizations should implement compliance approaches that comprise written standards of conduct, policies, and procedures to reveal their commitment to resolve issues such as code gaming, financial conniving between healthcare providers, and frauds during claim formation and submission. It is vital for organizations to reexamine their internal ethics and compliance code every so often and keep it up-to-date with the latest laws and regulations. The failure of compliance officers to maintain the policies and keep track of the compliance procedures can potentially lead to adverse consequences. The negligence of organizations in policy development and tracking can result in the creation of duplicate policies, leading to compliance breaches.

As per the SAI survey, half of the respondents admitted to conducting the compliance process manually, whereas one-third of them leveraged document management software. Only one-fifth of the respondents utilized a comprehensive document management system. Organizations can leverage artificial intelligence (AI) and similar technologies to automate the document management systems, not only to streamline the processes but also to ensure accuracy.

Rather than managing the policies manually, it is advisable to utilize practical policy management tools. By enabling a robust policy management platform, organizations can seamlessly develop, distribute, and update the relevant policies. For instance, CynergisTek, a cybersecurity and information management firm offers specialized solutions for document management, ensuring privacy, security, and compliance. Its privacy management solution is designed to manage and secure protected health information (PHI). A team of privacy executive, privacy officers, and privacy analysts keep track of the privacy environment, ensuring the adherence of organizational policies with the government regulations.

Compliance Strategy

The compliance officers typically draw annual work strategies to target high-risk areas and ensure their compliance with the relevant laws and regulations. They leverage a variety of resources to aid in their process, including OIG work plan, compliance risk assessments, previous government audits, and reported compliance investigations. It is also advisable to study the ongoing and recent auditing cases in high-risk areas to encourage the involvement of project managers in their respective areas.

Data analytics can aid the organization is sorting through loads of data and drawing actionable insights. It can assist the compliance officers in validating the effectiveness of the policies and ensuring the coordination of internal compliance audits and monitoring programs. To achieve optimal results, the compliance officers should formulate effective strategies to meet the compliance obligations with the limited resources available to them.

Leveraging the help of external compliance consultancy agencies such as EnviroMerica can also help the organizations in preparing for health inspections. The specialized team from the company conducts an initial assessment to identify the weak points of the healthcare center and offers subscription-based services, including onsite consulting and training, inspection protection, and medical waste management.

Compliance Training

Compliance training plays a crucial role in implementing healthcare compliance. The SAI report shows that almost 70 percent of the organizations deliver compliance awareness during employee orientation. Up to two-thirds leverage learning management systems, whereas only one-fifth of the organizations offer live training. Several organizations quoted it as the responsibility of compliance officers, whereas the rest reported it as an HR process. The best practice in the current environment is the employment of live training providers. However, it is expensive as well as time-consuming.

An effective compliance program requires regular training programs to educate the employees regarding the significance of healthcare compliance. Organizations can leverage tests and surveys to assess the effectiveness of the training programs and make upgrades accordingly. Data analytics can be used to assess the variation in behavior after training, enabling effective planning of future training sessions.

Compliance Channels

Organizations should have direct means of communication between the compliance officer and the employees. Since different employees prefer distinct channels to communicate, it is advisable to employ multiple communication channels. Flexible interaction with the compliance officer can make it easier for the employees to report wrongdoings, allegations, and complaints. Lack of communication channels can potentially lead to an increase in liabilities. According to the recommendations of the sentencing commission, OIG, DOJ, and other relevant authorities, the channels of communications should allow anonymous reporting and confidentiality of reporters. The best practice is to employ a professional hotline service provider to manage compliance communication channels. The channels should also be protected by secure encryptions and efficient cybersecurity.

In this regard, the solutions offered by Cytek can equip the organizations with the necessary tools to deter cyberattacks and data breaches in the communication channels. The Cytek Safeguard, a specialized offering by the company, performs a comprehensive assessment of the network and evaluates its compliance with the regulations. It also provides email and chat encryption to protect communication data.

Establishing healthcare compliance will not only enable organizations to adopt emerging technologies but will also pave the way for innovation. The new laws and regulations demand data privacy, protection of patient information, and open billing. Moreover, healthcare compliance will significantly enhance the capabilities of the organizations, allowing them to standardize the processes involved. 

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