Benchmark_Healthcare Compliance Essay_Trisha Dutrow
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Feb 20, 2024
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Benchmark – Health Care Compliance Essay Trisha Dutrow
Grand Canyon University HCA-460
Professor Thacker January 28, 2024
Benchmark – Health Care Compliance Essay
Maintaining compliance is crucial for a healthcare organization. Compliance is effective to ensure high-quality patient care. Compliance is an ongoing process of organizations meeting and excelling in both ethical and professional standards (Brownley, 2021). Compliance aids in decreasing risk while promoting a culture that encourages everyone to prevent, detect, and resolve any noncompliance issues. With regulations and policies constantly changing, it can be difficult for healthcare organizations to stay up to date on necessary changes. Many healthcare organizations operate under the supervision of governing organizations to help the facilities to establish guidelines, monitor behaviors, and ensure compliance. This essay will discuss governing organizations that oversee Kennedy Krieger Institute. This essay will also discuss noncompliance issues, how to monitor compliance, and explaining ways to ensure staff understands compliance. Kennedy Krieger Institute is an international resource for children that are diagnosed with
brain-related disorders in Baltimore, Maryland. It is crucial that Kennedy Krieger Institute ensures that accrediting and regulatory standards, guidelines, and regulations are being followed (Kennedy Krieger Institute, n.d.). The Kennedy Krieger Institute is governed by local leadership.
Kennedy Krieger Institute adhere to regulations from the Office of Human Research Administration to ensure that their patients involved in research studies are protected and safe. The Office of Human Research Administration ensures there is compliance with both the federal and state level regulations, while meeting IRB guidelines. With oversight provided by the Office of Human Research Administration, the Kennedy Krieger Institute makes research-based decisions on treatments to improve health (Kennedy Krieger Institute, n.d.). “Whether or not healthcare facilities participate in Medicare they must comply with the rules of the state’s
Department of Health” (Kavaler & Alexander, 2014). The Maryland Department of Health works
in conjunction with the Kennedy Krieger Institute to improve the health of Maryland residents through disease prevention, community engagement, and by ensuring access to safe and quality care (Maryland Department of Health, n.d.). The Maryland Department of Health drafts rules for the public to comment on. The Advisory Board is responsible for reviewing drafted rules, once the rules are finalized, the Maryland Department of Health forces the rules to be followed.
Federal and state laws are different in various ways, but both are vital. Legislation passed by respective governments is responsible for establishing rules and regulations for all United States citizens, with the federal government creating overall rules for all states. Individual state governments may pass legislation based on federal rules to fit their specific needs. “The public interest to be promoted by state enforcement is in the best interests of the state and its citizens, while federal enforcement serves the broader national interest” (Lemos, 2011). Conflicts may arise between the federal government and state governments, and state governments may try to pass legislation to avoid following federal rules. Regardless of compliance being a state and federal mandate, some healthcare organizations are found to be noncompliant. If the healthcare organization is found to be noncompliant, they can be at risk of costly penalties and end up with a bad reputation.
When a healthcare organization or healthcare professional does not follow the rules, regulations, and laws that are to be followed, this is considered noncompliance. It is crucial that all healthcare organizations follow requirements such as federal and state regulations, accreditation regulations, policies and procedures, financial requirements, and OSHA standard. If
these regulations and standards are not followed the healthcare organization can be faced with fines. Although noncompliance can cause financial issues for a healthcare organization, they can
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also struggle with losing licenses, business disruptions, unsatisfied patient care, loss of trust, and bad reputation. If a healthcare organization receives multiple fines for being non-compliant it can
cause a negative impact on the facility. “Depending on the violation, fines can range from $100 to $50,000, with a maximum fine of $1.5 million depending on the violation category, and the fine amount is multiplied by the number the healthcare organization allows the violation to persist” (Serrano, 2022). Ensuring that staff is always up to date on standards and regulations is important to maintain compliance. Establishing processes, policies and procedures can help with conducting, educating staff, and monitoring to help make their compliance program easier. Auditing and streamlining can help with making improvements in an organizations patient safety while reducing their compliance problems and mitigating risks. “The Patient Protection and Affordable Care Act requires all healthcare providers and suppliers to establish and maintain a compliance program that follows core elements that are established by the Department of Health and Human Services in consultation with the Office of the Inspector General” (Kavaler, 2014). It is crucial for an organization to have an effective compliance program to ensure prevention and protection against legal risk and regulatory risk. Abiding with state and federal regulations is important for monitoring and measuring. Evaluations and risk assessment analysis is conducted to aid an organization in determining the quantity and types of risks they face. Healthcare organizations can simplify their monitoring by using compliance software. Compliance software makes it easier to identify risk areas and helps organizations complete risk assessments to identify gaps in their compliance (Alexio, 2018).
An effective way to maintain compliance is achieving accreditation for healthcare facilities. It is important that the healthcare organization takes steps into making compliance
meaningful and ensure that conversations with employees are routine. “Strategic, innovative, and
effective communication all play an important role in ensuring that employees are responsible and content within their scope of practice” (Edlind, 2015). Communication methods such as training, newsletters, and policy updates all provide important information for staff to know the organization’s compliance. Implementing training helps with having staff remember compliance guidelines. Healthcare organizations can use a social media platform to help with real time communication for direct access to the organizations updated rules and policies. Organizational compliance is crucial. To mitigate risk, creating actionable methods for employees to receive critical compliance information is paramount.
Maintaining compliance is crucial when it comes to having safe and quality care within a healthcare organization. Through consistent supervision from governing organizations such as the Office of Human Research Administration, Maryland Department of Health, and Kennedy Krieger Institute have helped healthcare organizations maintain compliance by following federal and state regulations. Governing organizations have helped with identifying high-risk areas that need further development and effective monitoring. Upholding compliance is often time costly and time consuming. Risks and associated consequences of noncompliance can be critical for the
overall reputation of a healthcare organization.
Reference Page Aleixo, J. (2018, December 17). Healthcare Compliance Auditing and Monitoring
.
Emptech.com. https://emptech.com/healthcare-compliance-auditing-monitoring
Brownley, K. (2021, September 7). What is Healthcare Compliance & Definition - Gov Health IT
. Gov Health IT. https://www.govhealthit.com/healthcare-compliance
Edlind, J., & Edmond, K. (2015). How to Get Your Employees Talking about Compliance and
Ethics Building a Solid Plan, Keeping It Fresh, and Measuring What Works Are All Key
to Success. In Journal of Health Care Compliance
.
https://www.robinskaplan.com/~/media/pdfs/how%20to%20get%20your%20employees
%20talking%20about%20compliance%20and%20ethics.pdf?la=en
Fisher, C. F. (2017, November 21). How Can Leaders Acquire & Lose Power Within Their Organization?
Chron. Retrieved January 27, 2024, from https://smallbusiness.chron.com/can-leaders-acquire-lose-power-within-organization-
79558.html
Kavaler, F., & Alexander, R. (2014).
Risk management in health care institutions: Limiting liability and enhancing care
(3rd
ed.). Philadelphia, PA:Jones & Bartlett. ISBN-13: 9781449645656
Kennedy Krieger Institute (n.d.). https://www.kennedykrieger.org/research/research-
administration/office-of-human-research-administration-ohra/compliance
Lemos, M. (2011). State Enforcement of Federal Law
. Harvard.edu.
https://h2o.law.harvard.edu/text_blocks/187
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Reference Page
Maryland Department of Health. (n.d.). About MDH
.
https://health.maryland.gov/Pages/about.aspx
Serrano, H. (2022b, December 9). How to avoid the devastating consequences of HIPAA noncompliance
. HFMA. https://www.hfma.org/legal-and-regulatory-compliance/compliance/how-to-avoid-the-
devastating-consequences-of-hipaa-noncompliance/