Rehab

Tame the compliance program beast

Rehab Regs, April 1, 2004

Seven steps to creating a plan for your facility

Since no law requires providers to have compliance programs, creating one often takes a back seat to more pressing concerns in any rehab facility. But consider the time and money you could save if representatives from the Office of the Inspector General (OIG) come knocking on your door. When you present them with comprehensive documentation, an inclusive compliance plan becomes worth its weight in gold.

"Part of the OIG's responsibility is to ensure that all providers manage their businesses ethically and responsibly," says Iris Schumann, compliance specialist with the Polaris Group, a healthcare consulting company based in Tampa, FL.

"A comprehensive compliance program shows that you are interested in policing yourself," she says.

The OIG has created a list of seven components of an effective compliance program, drawn directly from the U.S. Federal Sentencing Guidelines. The guidelines include a section about white-collar crime and outline what citations a provider could be charged with, says Tessa Chenaille, CHC, president and chief executive officer of Chenaille Compliance Consulting, LLC, in Medford, MA.

"For example, if an outpatient clinic is investigated and found to be billing fraudulently, there will be a fine," says Chenaille. "But if you have an effective compliance plan, you self-report [any potential violations], and you're cooperative, your fines will almost definitely be reduced."

No matter what size facility you practice in, these guidelines can help you create an inclusive plan, says Schumann.

The following are seven ways to make sure your plan covers all the bases:

Develop written policies and procedures. For example, Chenaille suggests covering employee standards and codes of conduct that include reporting fraudulent behavior and adhering to written operational policies. "A compliance program is like an umbrella over the organization," she says. "It's easier to manage if you have general compliance rules and then more specific departmental policies."

Appoint a compliance officer and committee. Your outpatient clinic should name a high-level staff member to oversee the compliance program. At a large corporation, the compliance officer should report directly to the board of directors-because the chief administrative officer could be part of the problem. If your facility is small, the officer can be someone who wears many hats, like an office manager or billing officer, says Chenaille.

The committee will provide the officer with expertise in many areas and can include a therapist to review any clinical issues, a biller to review financial issues, etc. "When an officer gets a complaint, it can be reviewed by the committee, investigated by the officer or a designee, and then brought back to the committee for action," says Schumann.

Ensure effective communication and training. Some providers buy compliance programs and put them on their bookshelves. But if staffers don't know how to carry them out, the plans are useless. "It doesn't matter that you bought it, it matters that you've used it to train your staff," says Chenaille.

Also inform any outside vendors of your new compliance program. Schumann recommends sending a letter of understanding to each business and requesting they sign it in acknowledgement. "You're informing them that your company is doing business ethically and responsibly," she says.

Create a reporting mechanism. For any plan to succeed, employees must feel secure in reporting potential wrongdoings to the compliance officer without the threat of retribution. This mechanism can be in the form of a hotline, drop box, or Web site where staff can submit information anonymously.

"[A facility] needs to foster a culture of compliance," says Chenaille. "If you see something that's being done wrong, you need to feel like there's something you can do about it."

Additionally, stress to employees that they can submit comments without their names, but that you cannot guarantee anonymity. If the report results in a government investigation, the organization might have to reveal the identity of the employee to government investigators.

Also, employees will often talk about a potential violation with coworkers before they report it. If this happens, the facility cannot to be blamed for a breach of privacy.

Schumann adds that the level of comfort staff members feel in reporting potential problems can tell a lot about an organization.

"In long-term care facilities, I use this element to evaluate whether the chain of command is working well," she says. "If the frontline staff have complaints and feel they can't go to the administration, then the corporate culture doesn't lend itself to compliance."

Monitor and audit. Schumann considers these actions to be the most important. "An outpatient rehab facility recertifies its program on a regular basis," she says. "This can easily also become time to do some internal monitoring and auditing for the compliance plan."

To be sure the compliance program you've created is right for your facility, initially conduct a self-audit every six months and eventually once a year, says Chenaille. "If you can't show that people are comfortable with [the program] and know about it, then it won't be viewed as effective," she says.

Outline disciplinary actions. Another prong of a successful plan is to ensure that the standards you've created are consistently enforced by your facility. Be sure that your compliance officer acts fairly and consistently. Chenaille suggests that a statement regarding disciplinary action be part of your compliance program, but document the specific disciplinary policies in your facility employee handbook if you have one.

Address problem resolution. If your compliance program identifies a problem at your outpatient rehab facility, take steps to make sure the same problem doesn't happen again. Consider using an incident report form amended for compliance issues to document any problems and their solutions.

In some ways, merely having a compliance plan may stop problems from occurring. "Healthcare, by nature, is ethical," says Chenaille. "In general, providers want to do the right thing. So if we can foster cultural compliance, a lot of this stuff will take care of itself."

Once your organization begins operating with a solid compliance program, you'll soon wonder how you ever did without one.

"The initial development is time-consuming, but once you have a plan in place and have completed the training, it becomes second nature," Schumann says. "This is what we were supposed to be doing all along."

To review the OIG's compliance suggestions for outpatient rehab facilities, visit http://oig.hhs.gov/authorities/docs/physician.pdf and view Section II, titled "Developing a voluntary compliance program-A. The seven basic components of a voluntary compliance Program" on p. 59436.

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