Corporate Compliance

Tip: Quality of care

Compliance Monitor, June 16, 2010

Compliance officers are more involved than ever in the quality of care in America’s hospitals. Your job is to identify and address risks facing your organization and to take care of your patients by ensuring they receive the best possible care.

Insufficient quality of care may violate the Medicare Conditions of Participation (COP) as well as professional and facility licensing statutes. It can also put your organization at risk for tort liability and False Claims Act cases.

Many compliance officers already address quality of care issues. Compliance officers should implement the following best practices to safeguard quality of care:

  • Assign staff members overlapping responsibilities in compliance and quality of care. For example, members of the compliance committee can also serve on the quality committee. Members of both committees should focus on quality of care issues as part of their monitoring system.
  • Find several well-respected physicians who will work with you to get other physicians involved in improving quality of care. Involve your CEO and board in this process.
  • Consider appointing a compliance liaison in each department to make sure your organization’s hierarchy includes rank-and-file healthcare leaders. When making decisions that affect compliance and quality, integrate the organization’s leaders into the process.
  • Analyze how new systems will affect medical and billing errors. For example, although a new computer order processing system will likely improve efficiency, errors may increase as you implement the system. Test the system after implementation to ensure compliant outcomes. Analyze every process change to determine how the change may increase risk for the institution and providers.
  • Have your quality committee meet regularly. Establish priorities, choose what you’re going to monitor, and then get the data. Be sure to follow up with outlier physicians if you identify any problems.

This week’s tip was adapted from The Compliance Officer’s Handbook. For more information about the book or to order your copy, visit the HCMarketplace.

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