Will a Hotline Help?

The third rung of the ROPE Ladder for compliance success focuses on discovering and fixing problems. One effective mechanism for learning of problems is a telephone hotline.

The use of hotlines has grown because personnel who spot problems need to have a safe and effective way to report them to their bosses. Whether it is known as an employee information line, a compliance hotline or by some other name, the concept is now part of the corporate landscape.

Through the 1980s, the hotline concept was embraced by industries including defense contracting, banking, transportation, financial services and telecommunications. The fact that hotlines are only now becoming more common in the health care industry is somewhat of an anomaly. It is difficult to speculate as to why our industry has been slower to embrace this concept — it certainly is not because of lax government regulation!

Fortunately, home care companies can learn from the positive and negative hotline experiences of these other industries:

• Personnel use hotlines to report both actual and perceived problems. Not every tip is “hot,” but every tip must be evaluated.
• Hotline phone calls disproportionately involve human resources issues — regardless of why the hotline was created — regarding discrimination, sexual harassment, wrongful discharge, etc., additional to whatever violations of law, regulation or ethical codes are raised.
• The issues that come to management through hotlines are, on average, more sensitive than complaints that move through regular channels.

If handled correctly, a hotline can offer positive benefits to a home care company. At a minimum, a hotline provides an avenue for information to flow, identifying concerns that warrant attention. In addition, because the hotline encourages reports that are more sensitive than those that typically pass through regular channels of communication, it tends to identify problems that are not promptly or fully disclosed through regular channels.

Even when a caller utilizes a hotline to discuss alleged discrimination or harassment, rather than reimbursement or fraud issues, you may address these issues as well. Often, use of the hotline will forestall possible litigation and adverse publicity, because these types of calls are more likely to be handled by properly trained and carefully managed hotline personnel. Hotline staffers often bring extra sensitivity and the carefully coordinated transmittal of information to their discussions with whistleblowers, and these skills can ultimately help resolve the problem more efficiently and cost-effectively.

Hotlines are not overly expensive. Basic contracts can be under $100 or so monthly, depending on size and services.

Are hotlines essential? No. For large home care companies, hotlines, toll-free numbers, confidential voice mailboxes, suggestion boxes and regular interoffice communications may all be featured. On the other hand, such a comprehensive system would be prohibitive and quite impractical for small home care companies. Suggestion boxes may still be practical, though.

In truth, the specific choices a home care company makes to facilitate reporting are not the most essential decisions. Instead, here are decisions that are essential:

• Will you provide your employees with clear and repeated education about their individual responsibility to come forward?
• Will you use a compliance officer whom your employees trust and respect?
• Will you demonstrate commitment to non-reprisals?
• Will you demonstrate efforts to keep personnel communications as confidential as practical under the circumstances?

If you can answer these questions with a resounding “yes,” your reporting mechanisms should prove effective and invaluable.

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 June sometimes require you to refine your operating systems.

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