Wear Your Leathers!

Sit at my feet, Grasshopper. We continue our lesson about how to run your compliance program at peak effectiveness by comparing your home care company to a beloved motorcycle.

We explained how Rung 1 of our ROPE Ladder teaches us to fine-tune how you actually run your HME. This parallels your motorcycle’s major inspections. Rung 2 focuses on education and training, and correlates to your driving lessons. Rung 3 focuses on finding and fixing problems, which correlates to major and minor repairs for your motorcycle. Knowledge about how your company, or your bike, is actually supposed to operate is key to successful problem-solving.

Rung 3 also addresses the repair process itself. Your mechanic must understand how your bike should run in order to troubleshoot effectively. Sometimes you must answer his questions to help with the diagnosis or test the motorcycle to assess possible solutions. Similarly, in order for your company’s compliance team to troubleshoot efficiently and effectively, your non-compliance personnel will often be enlisted to provide necessary information or to test possible solutions.

Rung 4 of the ROPE Ladder looks at ongoing education. To operate your motorcycle at maximum efficiency, you should reread portions of your operating manual from time to time. And, family members whom you allow to ride your bike need to learn its strengths and weaknesses. Orientation also is required for new personnel joining your company, and even the most seasoned veterans need periodic refreshers in internal policies and “the rules.”

As your motorcycle ages, its operating efficiency will change. Perhaps it takes longer to warm up than previously. Perhaps the shift from first to second gear becomes rough. For your company, established relationships create compliance dangers distinct from those faced by newer companies. Giving Dr. Smith football tickets on the 50-yard line because he promises more referrals is a problem you would likely face only after you have a well-established relationship.

Re-education is needed for new technology as well. When you purchase new brake pads, you must assess new optimum hand and foot movements for smooth braking. In the compliance context, your personnel will need to find a new method for verifying accurate claims submissions when you move from manual to electronic claims submissions because there may no longer be a piece of paper to be reviewed and approved.

Old rules change and new rules are created. Trouble will arise if you fail to learn that your town recently passed a no-turn-on-red rule, or that highway speed was reduced to 60 mph. By the same token, trouble will arise if your personnel do not understand the new rules for mobility equipment or if they fail to confront proactively the types of physician cooperation they must obtain to demonstrate rule-compliant medical necessity.

Rung 5 of the ROPE Ladder focuses on monitoring internal systems. This correlates to your motorcycle’s ongoing scheduled maintenance. Beyond repairs, you must look at your bike proactively to verify that its gauges and dials are accurate, that its gas efficiency is reasonable and that it is not leaking oil or losing air.

This correlates to an HME company’s need for compliance protocols to work effectively. Are problems being reported appropriately? Are incident reports filed? Is corrective action fair and even-handed? Are tracking reports reviewed promptly? Are preventive audits on schedule, and are new rules and regulations assessed and implemented promptly?

In order for your motorcycle or your home care company to run efficiently and effectively, you need to verify that the tools that enable you to assess efficiency and effectiveness also operate well.

So, Grasshopper, learn to love your motorcycle. Learn how to tell when it is running well and when it needs maintenance or repair. So, too, learn to love your home care company. Learn what it needs to run effectively and efficiently, and when it needs monitoring or improvement. Use the ROPE system as the framework for this knowledge.

Neil Caesar is president of the Health Law Center (Neil B. Caesar Law Associates, PA), a national health law practice in Greenville, S.C. He also is a principal with Caesar Cohen Ltd., which offers compliance training, outsourcing and consulting and the author of the Home Care Compliance Answer Book. He can be reached by e-mail at [email protected] or by telephone at 864/676-9075.

The ROPE Ladder

Rung 1: Articulate the way you want things to run, and note how they run now. Then, tweak your systems as necessary to comply with “The Rules.”

Rung 2: Teach your operating systems to your employees.

Rung 3: Implement a clear and simple method for dealing with problems — identify them, report them, investigate them and fix them.

Rung 4: Give your compliance staff resources to help them keep up-to-date with internal and external changes that may sometimes require you to refine your operating systems.

Rung 5: Monitor your operating systems to make sure they continue to run as you intended.