Some health care companies treat “the rules” like viruses that spread panic and confusion within organizations. This seemingly infectious bug — the “compliance panic virus” — causes a dreaded disease: Rule Overload. But there is a vaccine for this disease.
One key prescription is training, but not specific training in HIPAA rules or anti-fraud rules or Medicare reimbursement rules. Rather, the cure is to teach your personnel how your day-to-day operational policies and procedures already address these rules.
The “rules” require you to have compliant policies and procedures, but they do not require that you teach or learn the hundreds of pages of regulatory rules. Instead, teach your staff how to follow your company's policies and procedures, how these policies and procedures deal with the rules and what to do when questions or concerns arise.
Instead of reciting HIPAA regulations, for example, show employees how your systems preserve patient confidentiality and privacy as a matter of sound medical practice.
Instead of discussing how the Balanced Budget Act of 1997 combines with the anti-kickback laws to regulate hospital discharge planning activities, preferred provider arrangements and unfair referral patterns, show your staff how your systems have been modified to address hospital marketing activities. Show your people how to bring problems to management's attention and how to ask questions. In other words, teach your people how to trust your company's systems.
To engender trust in your systems' ability to work compliantly, the ROPE system offers the following 10 secrets to effective training:
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Don't allow complex rules to produce over-compliance or ignorance.
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Avoid leadership by memo.
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Avoid the “do-it-because-I-said-so” teaching tool.
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Train for the job description.
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Management must commit visible time and effort to the training process.
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Write policies and procedures in a way that makes training easier.
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Formal training should be formal.
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Tailor training to your audience.
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Reinforce the real consequences of non-compliance.
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Good training is good leadership.
Let's discuss Secret No. 1: Don't allow complex rules to produce over-compliance or ignorance. Complex government rules create a perfect recipe for over-compliance that erects barriers to efficient and effective training, as well as to efficient delivery of services.
Because of the compliance panic virus, many health care providers consider virtually every activity they undertake as a potential violation of Medicare, HIPAA or some other rules. Then they implement ad hoc policies and procedures so frantically that they barely have time to write them down.
Others operate without carefully verifying compliance requirements, figuring that the burden of compliance outweighs the risk of non-compliance. Ironically, both reactions often magnify the paranoia that can be caused by the compliance panic virus.
Effective training can soothe these worries. Don't train rule memorization. Train how your internal procedures are compliant and how important it is to follow these procedures.
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 via e-mail at ncaesar@healthlawcenter.com or by telephone at 864/676-9075.
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 employees.
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.
