Why Bother?

Welcome back to Compliance University! Today we apply fresh, new perspectives to The Question They Dare Not Ask: “Why should I bother?”

In December, I established the premise that any home medical equipment provider without a working regulatory compliance program is, in effect, deciding that there is no need to bother with compliance. This phenomenon certainly is not limited to HME providers. Medical groups, ancillary service providers, long-term-care organizations and even hospitals continue to operate without compliance programs in place.

Last time, I presented six reasons to bother with a compliance plan, focusing on staying out of trouble with the government. While these reasons certainly are important, too often they are the only issues that providers consider. In fact, there are at least 12 additional benefits from an effective compliance program, which have nothing to do with federal or state, fraud and abuse rules, or with Medicare or Medicaid programs.

The next six reasons focus on how compliance programs may improve your internal communications and personnel relationships.

7. An effective compliance program can improve internal communications.

The plan demonstrates to company personnel that the organization intends to learn and follow rules, and to investigate possible violations of law and/or company rules. Additionally, it encourages personnel to communicate their concerns about violations or other problems.

Both of these components demonstrate to your employees your commitment to a corporate culture of compliance, and to a workplace that welcomes productive feedback from its staff members. It proves to your employees that you value their opinions.

At its core, a compliance program is an internal communication system for reimbursement and fraud rules, for the Health Insurance Portability and Accountability Act, and whatever else the company includes in the program.

8. The same internal communication mechanisms used in an effective compliance program can become the cornerstone of a general program, which encourages focused and constructive feedback to forge sensible solutions for operational problems.

One problem many HME providers face is ineffective or destructive communication by personnel. Idle, unfocused complaints — unaccompanied by practical options for solving the problems — can hurt morale and impair a company’s effectiveness.

It helps to recognize that the underlying theme of an effective compliance program essentially is, “We want to do things correctly. We need everyone’s help to identify when things are not being done correctly, and why. We want procedures in place to make it easier to fix problems.”

This is a useful philosophy for an HME provider to embrace in most aspects of its operation. Providers should encourage personnel feedback on all topics — not merely compliance-related items — as long as the feedback facilitates identifying a problem, the reasons for a problem or an approach to resolving a problem.

A system that encourages focused, constructive problem-identification and problem-solving also can be used to communicate and explore new ideas or business opportunities.

9. You can use some of the communication procedures you create for a compliance plan to disseminate other sorts of information as well.

An effective compliance program creates and uses internal channels of communication, so that problems and solutions can be reported and investigated efficiently.

For instance, if compliance issues are reported to senior management regularly, this exchange can be expanded to include the reporting of other useful information.

Additionally, if compliance requires changes in departmental procedures, these changes must be communicated in some formal fashion. This same communication system can convey new departmental information or policies, even if the policies are not related to compliance issues.

10. The ongoing training that is part of an effective compliance program will help heighten employee awareness of ethics issues.

Compliance issues do not always fall neatly into divisions of right and wrong. The first step in resolving ethical problems effectively is to identify when they may exist.

An effective compliance program also heightens staff members’ awareness of ethics issues, for a variety of reasons. First, it reaffirms that you are committed to full compliance with the law. Second, the ongoing monitoring and auditing process that is part of an effective compliance program ensures communication about what sorts of issues or activities may raise ethical questionss.

As your compliance program matures, your personnel will become more skilled in investigating and resolving ethics issues. A compliance program’s implementation begins with appropriate training for all personnel. HME providers often value training that includes some “hands-on” case studies and exercises designed to increase staff members’ sensitivity to ethics issues.

In this context, effective problem-solving usually requires personnel to recognize the potential problem, investigate the problem to confirm that it actually exists and solve the problem using methods such as prohibition, incentives, education and sanctions.

11. An effective compliance program keeps you aware of pertinent new laws, and creates protocols specifically crafted to teach employees how to identify whether rules are being followed appropriately.

Thus, when a new law requires you to incorporate changes into your operations, it is easy to identify which formal policies and protocols require modification, and to make those modifications quickly and efficiently.

12. Finally, an effective compliance program includes an ongoing commitment to monitor and audit continued compliance.

This creates a process whereby senior personnel can discuss changes in the law, how these changes may impact the company, and whether these changes require the company or its auditors to look for new areas of potential noncompliance. This cuts down on the time during which you may inadvertently be out of compliance with new laws and regulations.

The next installment of Compliance University will wrap up our discussion of the many benefits of an effective compliance program, answering The Question They Dare Not Ask. We will focus on the ways an effective compliance program helps your relations with business colleagues, financiers and customers.

There’s the bell. Class dismissed!

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