COMPLIANCE & THE C-SUITE

Transcription

1 COMPLIANCE & THE C-SUITE BECKER S HOSPITAL REVIEW MAY8, 2015 SESSION HIGHLIGHTS UNDERSTANDING A CEO S EXPECTATION OF COMPLIANCE IN A HIGHLY REGULATED ENVIRONMENT COMMUNICATING COMPLIANCE ISSUES TO THE EXECUTIVE BRANCH IMPLEMENTING COMPLIANCE TO A HOSPITAL S VISION, MISSION& VALUES TRANSFORMATION OF HEALTHCARE INCREASED NUMBER OF REGULATIONS ADAPTATION TO CHANGE IN ORDER TO: PROVIDE HIGH QUALITY SAFE CARE MANAGE NEW ILLNESSES EMBRACE SCIENCE& TECHNOLOGY DEPENDENCY OF COMPLIANCE PROGRAMS IN THE FACE OF INCREASED ENFORCEMENT 1

2 CEO S CHIEF OBJECTIVES: TONE AT THE TOP ENSURE BEST QUALITY& SAFEST CARE GIVE THE HOSPITAL A COMPETITIVE ADVANTAGE SERVICE EXCELLENCE DEVELOPING THE RIGHT ORGANIZATIONAL CULTURE HIRING EMPLOYEES WITH THE BEST CHARACTER& PERSONALITY CHARACTER & PERSONALITY CHARACTERISTICS NECESSARY TO ACHIEVE SUCCESS AS COMPLIANCE PROFESSIONALS CHARACTER& PERSONALITY ALLOWS COMPLIANCE PROFESSIONALS TO: ADVANCE THE INSTITUTION S MISSION; AND ENGAGE& COLLABORATE WITH EMPLOYEES OF ALL LEVELS CHARACTER & PERSONALITY ALWAYS LOOK TO HELP EMPLOYEES WELCOME OPPORTUNITIES TO BEBETTER ENGAGES EMPLOYEES RALLIES EMPLOYEES ENGAGE IN AN EFFORT TO PROTECT BEBOLD BELIEVE INYOUROPINIONS BUILDTRUST 2

3 KNOWLEDGE KNOW YOUR FIELD RESEARCH READ BUILD RELATIONSHIPS KNOW THE IMPACT YOUR RECOMMENDATIONS HAVE DETERMINE OPERATIONAL SOLUTIONS TO KEEP DEPARTMENTS ON THE RIGHT PATH TO SUCCESS KNOWLEDGE COMPLIANCE OFFICERS HAVE AN ENORMOUS RESPONSIBILITY BE THE MORAL BACKBONE OF YOUR ORGANIZATION UNDERSTAND HEALTHCARE TO GUIDE THE ORGANIZATION TOWARDS WHAT IS RIGHT KNOWLEDGE IMPROVES RELATIONSHIPS WITH: CHIEF OPERATING OFFICER(COO) CHIEF FINANCIAL OFFICER(CFO) CHIEF MEDICAL OFFICER(CMO) CHIEF NURSING OFFICER(CNO) LEGAL COUNSEL COUNSEL INTERPRETS LAW COMPLIANCE KNOWS THE OPERATIONAL IMPACT 3

4 DRIVES SUCCESS IN ALL OTHER FACTORS SUCCESSFUL IS DETERMINED BY YOUR ABILITY TO BE EFFECTIVE& TIMELY WITH YOUR MESSAGE RECITATION OF STATUTES WILL NOT ENGAGE IT WILL NOT CONVINCE TELL ASTORY GIVEREALEXAMPLES FROM YOUR INSTITUTION EXECUTIVE& BOARD LEVEL REPORTING NO SURPRISES COMMUNICATE WITH PURPOSE KNOW WHAT CEOS NEED TO KNOW IMMEDIATELY KNOW WHAT CAN WAIT KNOWYOURBOARD UNDERSTANDTHEIRFIDUCIARY& JUDICIARY RESPONSIBILITIES COMMUNICATE WITH A CEOS EXECUTIVE TEAM FIRST COMPLIANCE IS PART OF THIS TEAM EXPECTATIONOF ACEO THATTHISTEAM TOMITIGATE ISSUES OF NON-COMPLIANCE 4

5 PRIVACY INCIDENTS: NOTIFY CEO KNOW ALL THE FACTS NOTIFY LEGAL, HR & PATIENT RELATIONS DO YOU HAVE A BREACH? EXCLUDED PROVIDER: NOTIFY CEO HAVE A CORRECTIVE ACTION PLAN READY NOTIFY COO, LEGAL, CFO, CMO, CNO & HR DO YOU HAVE A POSITIVE MATCH? CMS NOTIFICATION OF OVERPAYMENT: NOTIFY CEO HAVE A CORRECTIVE ACTION PLAN READY INTERNAL INVESTIGATION TO DETERMINE EXPOSURE NOTIFY CFO, CMO & LEGAL 5

6 MEANINGFUL USE AUDIT: UPDATE WITH CMS FINDINGS NOTIFY YOUR BOARD NOTIFY CEO, COO CFO, & LEGAL ONCE NOTICE OF AUDIT IS RECEIVED BOARD REPORTING: QUARTERLY REPORTING AT MINIMUM PROVIDE THEM THE INFORMATION TO HELP THEM MEET THEIR RESPONSIBILITIES EDUCATE PROMINENT COMMUNITY MEMBERS, NOT NECESSARILY WELL VERSED IN HEALTH CARE OPERATIONS OPTIMIZE THE PERFORMANCE OF YOUR DEPARTMENT LEARN THE DIRECTION HEALTHCARE& YOUR ORGANIZATION IS MOVING IN PROVIDE RELEVANT GUIDANCE 6

7 TRIPLE AIM CURRENT APPROACH TO PROVIDING HEALTH CARE INCREASED LONGEVITY OF AGING POPULATION CHRONIC HEALTH PROBLEMS NEW DEMANDS FULFILLING THIS AIM REQUIRES: FOCUS ON INDIVIDUALS& FAMILIES REDESIGN PRIMARY CARE SERVICES& STRUCTURES MANAGE POPULATION HEALTH CREATE A COST CONTROL PLATFORM; AND SYSTEM INTEGRATION& EXECUTION COMPLIANCE INVOLVEMENT IN TRIPLE AIM ACCOUNTABLE CARE ORGANIZATIONS BUNDLED PAYMENTS INNOVATIVE FINANCIAL APPROACHES NEW PRIMARY CARE MODELS PATIENT CENTERED HOMES SANCTIONS FOR AVOIDABLE EVENTS INTEGRATION OF INFORMATION TECHNOLOGY 7

8 PAY-FOR-PERFORMANCE FINANCIAL INCENTIVES TO HEALTH CARE ENTITLES MEASURED BY: PROCESS MEASURES OUTCOME MEASURES PATIENT EXPERIENCE STRUCTURE MEASURES PATIENT EXPERIENCE& PATIENT SATISFACTION STRIVE TO EXCEED PATIENT EXPECTATIONS COMPLIANCE OFFICERS SUPPORT PATIENT SATISFACTION ROUND UNIT FLOORS TO: ENGAGE FRONT LINE STAFF EDUCATE FRONT LINE STAFF PERFORM HIPAA SAFEGUARD REVIEWS PATIENT EXPERIENCE& PATIENT SATISFACTION STRIVE TO EXCEED PATIENT EXPECTATIONS COMPLIANCE OFFICERS SUPPORT PATIENT SATISFACTION ROUND UNIT FLOORS TO: ENGAGE FRONT LINE STAFF EDUCATE FRONT LINE STAFF PERFORM HIPAA SAFEGUARD REVIEWS 8

9 LEADERSHIP COMPLIANCE OFFICERS MUST BE LEADERS CEOS SET THE TONE OF THE ORGANIZATION CEOS HIRE INDIVIDUALS TO LEAD THEIR DEPARTMENT BE THE CEO OF YOUR DEPARTMENT QUESTIONS 9

10 SPEAKERS FRANK CORVINO PRESIDENT, CORVINO& CORVINO CONSULTING RETIRED-PRESIDENT& CEO GREENWICHHOSPITAL; EXECUTIVE VICE PRESIDENT YALE-NEW HAVEN HEALTH SYSTEM FAHAD AHMED COMPLIANCE& PRIVACYOFFICER, BRIDGEPORT& GREENWICHHOSPITAL; DIRECTORCOMPLIANCE& PRIVACY, YALE-NEW HAVEN HEALTH SYSTEM 10