We climb the second rung of the ROPE (Rule Overload Prevention and Elimination) Ladder by teaching our operational systems and the that shape our systems
by Neil Caesar

We climb the second rung of the ROPE (Rule Overload Prevention
and Elimination) Ladder by teaching our operational systems —
and the “Rules” that shape our systems — to our
personnel. We have previously identified eight methods that can
help convey knowledge, motivation and enthusiasm during the
teaching process. Two final training suggestions focus on
accountability at both ends of the corporate ladder.

In a healthy organizational culture of compliance, personnel
realize that company leadership is ready and willing to help them
comply with law, policy and procedure. But there must be clear
expectations of compliance, and unambiguous consequences for
failures, whether inadvertent, negligent, or intentional. There
must be discussions of the company's compliance expectations, with
tactful references to other employee policies on topics like
progressive discipline.

Employees should be taught to properly respect — not fear
— the consequences of non-compliance, but they must
appreciate the reality of enforcement. Sometimes the reality is
sobering, as with fraud investigations or substantial reimbursement
investigations. Other times the reality is more benign, as with
HIPAA enforcement.

While staff should be reassured that HHS is not planning any
sweeps, dragnets or witch-hunts, they must understand that a
complaint by a patient or other affected person can result in
serious consequences for both the organization and the

Even more important, personnel must be taught to comply with
your policies and procedures simply because they are your
policies and procedures — not because the law says so, not
because government penalties may follow — but because the
policies and procedures were created for good reasons, and because
it is better to address policy flaws through official channels than
to ignore the policies altogether. Remember our central premise:
Teach your compliant internal policies; don't teach the Rules.

When you discuss enforcement issues, include updated enforcement
statistics and anecdotes. This will enable your employees to
imagine themselves in the place of those who become subjects of
enforcement actions, and thus ponder the inherent danger of a
casual attitude toward HIPAA compliance.

Finally, remember at all times to integrate enforcement
discussions with your own internal needs for compliance. The key is
to require compliance because “that's how we do it,”
— for reasons that include profitability, efficiency,
inventory control, record keeping or anything else — as well
as compliance with the Rules.

By offering effective training, home care companies can
inoculate their personnel against rule overload. Good training is
good leadership, and good leadership in compliance program training
will help foster a culture of trust and cooperation where staff and
employees strive to do what's right and self-enforce compliance on
a daily basis.

Meaningful, ongoing compliance training prevents both foolhardy
carelessness and destructive over-compliance, which can erect
barriers to efficient health care delivery. Meaningful, ongoing
HIPAA training gives staff and employees the tools to carry out
their part of your overall compliance program.

During the past several months, “Compliance
University” has focused on training techniques to help your
employees understand how to utilize the ROPE System as an asset to
your success. Together, these techniques teach the following

We're all in this together.

  • We want to do this the right way, legally and ethically, as well
    as for competitive success.

  • We need the help of our entire workforce to do this

  • Here's how to do it correctly. (Describe your own actual

  • Here's what to do if something does not seem right to you.

    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 ncaesar@healthlawcenter.com or by telephone at

    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

    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.

    Materials in this article have been prepared by the Health Law
    Center for general informational purposes only. This information
    does not constitute legal advice. You should not act, or refrain
    from acting, based upon any information in this presentation.
    Neither our presentation of such information nor your receipt of it
    creates nor will create an attorney-client relationship.