Compliance Programs – Part 2

Though this keynote was presented in 2010, practices have seen these topics change how they operate over the last 10 years. With greater patient and caregiver involvement in care plans, innovation, and growth in use of technology, we will see greater demand for these key issues by all stakeholders in healthcare.

Some Questions Compliance Professionals Should Ask as They Prepare for Health Care Reform

Highlights of Keynote delivered by Daniel R. Levinson, Inspector General for HHS at the Health Care Compliance Association’s Annual Compliance Institute, April 19, 2010

  • Transparency: Are you prepared to operate in a more transparent health care system?
  • Quality: Are you focused on quality as a compliance issue?
  • Accountability: Is your organization prepared for greater accountability?

Fast forward to 2021, have these compliance “predictions” come to pass?

Transparency: Provisions in the 21st Century Cures Act (Cures) of 2016, prohibits Information Blocking. As of April 5, 2021, healthcare providers, HIT, health information networks or exchanges (HIN or HIE) are governed by rules and regulations regarding access to patient health information.

According to the AMA, “Physicians may implicate the info blocking rule if they knowingly take actions that interfere with exchange, access, and use of EHI, even if no harm materializes. A physician organization, for instance, may
have a policy that restricts access to patient lab results for a certain amount of time. Even if patients are not
aware there is a delay between when the results are available to the physician and when they are made available
to the patient, a practice that is merely “likely” to interfere with the access, use, or exchange of EHI could be
considered info blocking.”

Quality: There are numerous articles regarding the False Claims Act recovering millions in healthcare related fraud due to “medically unnecessary services or services not rendered as billed.” The U.S. Justice Department levied millions in fines in 2020 for not reasonable or medically necessary services / tests.

Accountability: If you google “healthcare accountability,” you will see that there are many types of accountability. There is legal accountability, patient accountability, personal accountability, systems accountability, leadership accountability, and more. CMS developed a program called Accountable Care Organizations (ACOs). ACO’s are accountable to:

  • voluntarily to give coordinated high-quality care to Medicare patients;
  • coordinate care to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors;
  • deliver high-quality care and spend health care dollars more wisely

As a compliance professional, you are part of your organization’s program to provide transparent accountable quality of care to the patients and families who count on you.