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Quality of Care Compliance |
We are entering a new era of thinking about healthcare quality compliance. New criteria to measure healthcare quality are being released every day. And the U.S. Department of Health and Human Services Office of Inspector General (OIG) has made enforcement of standards of care a priority and are actively pursuing providers who fail to meet these standards.
Effective compliance for quality of care is an asset for both the organization and the healthcare delivery system. However, Governing Boards of Health must now respond to important new developments---clinical, operational and regulatory—that affect reimbursement and payment, efficiency, cost controls, and collaboration between providers, that are now tightly linked to with quality of care compliance.
KEY DEVELOPMENTS
- More severe sanctions and monetary penalties may be imposed against providers that fail to comply with regulatory requirements addressing quality of patient care. Sanctions range from monetary penalties to exclusion from federal and state healthcare programs and prison sentences for the most serious offenses.
- All levels of healthcare organizations, from the direct caregiver to the governing body of an institutional provider, could face serious consequences for failing to meet the quality of care obligations applicable to government program providers.
- Authorities are carefully scrutinizing quality of care reporting data. Inaccurate reporting could result in misrepresenting patients’ care status and cause the submission of false claims leading to large fines and penalties.
- Institutions will need to pay much closer attention to their structure and processes to ensure that their data is accurate and addresses potential quality of care issues.
- Thirteen nursing homes are now operating under quality of care corporate integrity agreements, under the oversight of an independent review organization.
HOW CAN DAYLIGHT HELP
Daylight healthcare compliance professionals have extensive expertise to address patient quality of care issues and ensure that your organization is in compliance with all federal, state and local regulations. We have devoted considerable time and resources to this highly active area of enforcement. Our services specifically relating to patient quality of care include:
- Development of required policies and procedures specifically addressing patient quality of care issues.
- Development and Implementation of training and education materials focusing on applicable laws, regulations and policies addressing quality of care and the processes in place in the organization to ensure compliance by all employees.
- Devise a compliance program tailored to quality of patient care issues
- Serve as an independent review organization for an existing corporate integrity agreement
- Conduct risk assessments of all policies, procedures, systems, operations and resources to evaluate whether the organization is in compliance with enforceable quality of care legal and compliance requirements.
- Targeted analyses of medical records, billing systems and claims, with a focus on quality of care and reimbursement.
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