October 2017 Takeaways
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A checklist approach for conducting
by T. Jeffrey Fitzgerald and Asher D. Funk
» Creating and using a checklist that outlines
your compliance investigation process has
» In other professional settings, checklists have been
shown to be highly effective.
» Checklists help to reduce mistakes or process errors
while increasing consistency and uniformity.
» A checklist-based process will help reduce the
emotions and stress that often comes with an
» Using a checklist will help demonstrate that a
compliance program is “effective” by documenting
and explaining the provider’s compliance
What it takes: An effective program
by Mary Ellen McLaughlin and Shawn Seguin
» Ensure direct access to the Board and that there is
high-level oversight and buy-in.
» Maintain an “open-door policy.” It is best to have an
office away from the C-suite.
» Ensure a non-punitive, non-retaliatory program.
» Provide education to the employees so that they
know what needs to be reported and where to
» Make it a collaborative program, engaging all key
department managers to ensure buy-in.
An organizational strategy
for 2017 and beyond
by Steven Ortquist (page 38)
» Compliance programs must be strategic— aligned
with organizational strategy and key risk areas — to
be effective in preventing compliance risks.
» Informed and engaged leadership by an
organization’s executives and board is essential to
compliance program success.
» A compliance program is programmatic, and
core compliance functions must be part of the
compliance program and must be structured
and operated in tandem if the program is
to be successful.
» A compliance officer’s role is to implement and
operate the compliance program— the role is not
responsible for “assuring compliance.”
» Executive and board leaders must be actively
engaged in establishing compliance program
strategy and providing appropriate resources and
oversight, or the compliance program will falter and
may fail in its objectives.
Key Stark Law developments
thus far in 2017
by Gary W. Herschman and Yulian Shtern
» Hospitals and other healthcare providers
should adopt and strictly implement a physician
» Physician contracting practices should be
closely monitored to ensure compliance with the
» Compliance personnel should look beyond written
agreements (e.g., professional services agreements,
leases) to identify any free items or services that are
being provided to physicians.
» Compensation based on work relative value
units (wRVUs) or other performance metrics
should be verified with evidence of personally
» Hospitals and other healthcare providers should
conduct periodic Stark Law audits of their existing
Courts and compliance:
Controlling legal risks for pharmacies
by Stacey Supina (page 53)
» The opioid epidemic has resulted in plaintiffs
seeking compensation from a variety of sources,
» Private causes of action against pharmacies may
arise from regulatory compliance failures.
» Pharmacies may also face liability for negligence if
professional “duty of care” standards are not met.
» Even if the pharmacy overcomes these claims in
court, the process is still expensive.
» The best practice is to track relevant court decisions
and to update compliance programs accordingly.
Telemedicine service arrangements
and fair market value assessments
by Christopher Fete, Alianna Goff, and
Nathaniel M. Lacktman (page 58)
» The use and implementation of telemedicine
» Important compliance issues should be considered
when entering into telemedicine arrangements.
» Fair market value (FMV) and commercial
reasonableness are important pieces of the puzzle.
» Telemedicine arrangements vary by service type and
» The structure of the arrangement
impacts the assessment of FMV and
Joint Commission readiness
by Karen L. Parton (page 66)
» Add The Joint Commission standards to your
» Use yearly National Patient Safety Goals to stay on
top of emerging issues.
» Be part of The Joint Commission Readiness team.
» Add to the effectiveness of your
» Use the team-based approach at your facility.
Partner with Learning & Development
to save resources
by Marla S. Berkow (page 69)
» Learning is corrective and preventive and helps
» Educating in response to violations coaches and
develops employees’ self-confidence for making
» Learning is established in most organizational
leadership development infrastructures.
» Many corporate compliance issues should be treated
as teachable moments.
» Training departments have an existing
communication infrastructure and resources.
Clinical documentation: 10 means
for compliance and convenience
by Ellis “Mac” Knight (page 71)
» Avoid poor clinical documentation practices that
commonly result from limited time for direct patient
care and documentation.
» Mitigate the deleterious effect documentation in the
electronic medical record can have on face-to-face
patient care delivery.
» Ensure compliant documentation of care is
accomplished in the most efficient and effective
» Prepare for value-based reimbursements, where
both clinical documentation and abstraction of
performance data from the medical record will be
required for billing purposes.
» Step back to re-tool provider clinical documentation
processes and procedures.