Compliance chiefs: Flexibility, operations keys to success
As health care compliance efforts mature, compliance officers take stock
In a few short years, the health care industry has gone from concept to development in its compliance efforts, and now it’s moving to managing program effectiveness. Vickie McCormick, integrity officer at UnitedHealth Group in Minneapolis, says that while people keep looking for the "magic bullet" for structuring a compliance program, one of the lessons of the past few years is that no single model will work for all organizations.
"You really need to look within your organization and understand its dynamics, culture, and personality as well as its size, structure, and geography," McCormick says. For example, because UnitedHealth has a number of separate operating units, it also has a number of different models. "What works well within an HMO may not work within an employee assistance program," she explains.
McCormick says another important lesson deals with "operationalization." That means compliance officers must make sure that compliance activities are part of the operational staff responsibility. She says that, too often, compliance is "siloed" and tasked with making sure the rest of the organization is in compliance with all laws and requirements.
"That isn’t going to happen," she argues. "Every person within the organization must understand that he or she is responsible for making sure that their area is compliant." If you "silo" compliance in a single department, you are going to have endless problems in the rest of the organization, she warns.
McCormick says another lesson is that compliance officers should use the systems they have in place and get to know people in the functional departments, such as human resources, public relations, and accounts payable. For example, she says communications has helped make the information sent out to employees more "user-friendly" and less legalistic.
McComick says public relations also helped her develop a consistent "look and message" that helps to promote a brand identity for the compliance program. "Compliance officers are marketing the compliance program to employees, so when they see something, they identify it with the compliance program," she explains.
Similarly, she says that when UnitedHealth recently moved to an on-line exit interview process, she worked with the human resources department to develop a process to include three questions focusing on integrity and compliance. "If anybody answers those questions positively, I receive an e-mail notification and can see what those responses are," she reports.
In addition, McCormick says she works with accounts payable to identify business associates for Health Insurance Portability and Accountability Act compliance. "They are the ones who send out the checks, and they know a large percentage of who it is that would constitute a business associate," she explains.
McCormick says she also works with accounts payable as a backup on background checks for the OIG when checking for outside vendors. "As a safety net, we have accounts payable do a check of all new vendors before they are entered into our system and then an annual check of all vendors," she explains.
Often, the simple lessons are the most difficult to grasp and remember, says Anthony Boswell, corporate compliance officer at Dallas-based Laidlaw Inc. "Never underestimate the need for a training session," he says. Since most information is forgotten within a month, compliance officers must constantly be out in front of the employee base sharing new information and reinforcing existing best practices.
Boswell notes that a strong private sector ad campaign usually lasts only six months. Compliance officers must think along the same lines and refresh their message continually, he says.
In addition, old habits die hard. That means compliance officers must encourage employees who are eager to adopt best practices and use auditing and monitoring programs. "Training an employee base is similar to raising children," he says. "You can’t be there all the time."
Also important is to learn and speak the language of business, Boswell says. "We are being asked in new and creative ways to demonstrate the value that we as compliance departments bring to organizations," he reports. "If we can’t do that in dollars and cents, I fear that we will lose some of our effectiveness’ in the minds of business people," he asserts.
Already, he says, there is a large "push-back" based on budgeting, and part of that results from a lack of understanding about the value of compliance. The formula for demonstrating that value will vary from organization to organization, but accomplishing it in some fashion is critical, he says.
John Markus, senior vice president of Fresenius Medical Care North America in Lexington, MA, says the major challenge for compliance officers over time is to stay focused and avoid complacency. He points out that a seven-figure settlement in the 1980s was noteworthy. Today, settlements can reach several hundred million dollars. "Sometime within the next few years, somebody is going to pay a billion dollars," he predicts.
Markus says the government is methodically expanding its reach throughout the health care industry, from labs and hospitals to skilled nursing facilities and home health. "There are countless FBI agents and countless OIG agents who have nothing better to do than open investigations," he says. A final lesson of the last few years is that providers can count on that to continue, he says.
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