Corporate Compliance

Tip: Quality of care

Compliance Monitor, September 22, 2010

Compliance officers are more involved than ever in the quality of care in America’s hospitals. The compliance officer’s job is to identify and address risks facing the organization and to take care of 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 the organization at risk for tort liability and False Claims Act cases.

  • Compliance officers should implement the following best practices to safeguard quality of care:
  • Implement an adverse event-reporting system. Analyze the reported issues to determine and assess quality concerns and analyze what process or procedure has caused the issue.
  • Address quality management from a clinical standpoint. The Joint Commission recommends having in a planned, systematic, organization-wide approach to performance management and improvement.
  • Work with your quality committee to develop clinical guidelines. Note that some physicians see such guidelines as a way to standardize medicine. They may not like clinical guidelines because they want to use their own clinical judgment. Nevertheless, it’s becoming more common for the standard of care to be well defined. The involvement of your medical staff in the development and implementation of the clinical guidelines is very important.
  • Report substantiated allegations of substandard care to the compliance committee and hospital board.

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.

Most Popular