Healthcare organizations must aim to better understand compliance program issues and how Compliance Officers and organizations respond to these issues. To remain competitive and agile, it is critical for organizations to stay up to date on evolving healthcare compliance program trends.
To identify and analyze recent healthcare compliance trends, SAI360 conducted its 14th annual study and U.S. industry benchmark survey. This study was conducted in partnership with Strategic Management Services. Survey respondents were mainly hospitals as well as skilled nursing facilities, long-term care home health and hospice organizations, managed care plans, physician practices, and ambulatory surgery centers.
Below, we present three key highlights from our research for organizations looking to monitor ever-evolving compliance needs.
3 Healthcare Compliance Trends to Know Now
1. Compliance Officers Have Skin in the Industry
“We are beginning to move to a highly experienced Compliance Officer world,” said Richard Kusserow, in an SAI360 webinar that covered research results. Kusserow is the former Health and Human Services (HHS) Inspector General and CEO of Strategic Management Services, and study co-lead.
Compliance Officers are a critical part of management teams, helping to oversee compliance and ensure compliance with laws, regulatory mandates, policies, and procedures.
Indeed, Compliance Officers’ professional experience—including compliance work—now averages over eight years.
In terms of what this experience looks like in more detail, Compliance Officers’ education backgrounds vary. Nearly one in three Compliance Officers have a legal education. Additionally, 22 percent have education in one of the following: medical, nursing, clinical, and business administration. And over one in ten have a finance education. At five percent each was government/public administration, personnel management, and arts/science education.
There is a near even, half-and-half split between C-level executive Compliance Officer roles, like senior vice presidents and vice presidents (48 percent) and senior management roles, like directors (48 percent), with other roles comprising four percent.
Over half of Compliance Officers report directly to Chief Executive Officers (CEOs), as called for by the Office of Inspector General (OIG) and the Department of Justice (DOJ).
Establishing best practices regarding the public visibility of your highly skilled and educated senior-level Compliance Officers is critical to ensure compliance.
“If you are a Compliance Officer and your organization has senior leadership on your website, you should make sure your organization knows it’s a best practice to have your Compliance Officer there as well,” said Kusserow. “It’s one of the first places the OIG and DOJ look to see whether they were a senior-level executive in the organization.”
2. Compliance and Resources are Top Priorities
The top challenges cited by respondents included addressing compliance in high-risk areas and battling resource limitations while trying to meet office challenges.
More than two-thirds of those surveyed said they want to improve the ongoing compliance monitoring and auditing portion of their compliance program.
Said Kusserow, “People want evidence that their program is effective.”
Respondents’ four top priorities for compliance program improvement, in order of importance, are:
1. Improving how compliance auditing is conducted
2. Staying current with changing regulatory and enforcement environments
3. Improving the quality of compliance education and training
4. Building better relationships with leadership
Priorities are shifting as Compliance Officers look to improve their compliance programs amidst a new staffing reality brought on by the pandemic and Great Resignation. In the meantime, Compliance Officers’ proactive and continuous involvement in business strategy development is key. Yet only one in three respondents said they do so.
Urged Kusserow, more Compliance Officer involvement is necessary. And Compliance Officers “should be actively involved in development meetings,” he stressed.
“Ask yourself where you fall,” he said. “If they’re talking about mergers and acquisitions, new clinical services that are going to be provided, or new relationships that are going to be established, Compliance Officers should at least have the perspective to point out what might be compliance risks with whatever strategy is being considered.”
Doing so ensures for the DOJ you have an effective compliance program, he emphasized.
3. More Independent Evaluations are Needed
Almost one in two—47 percent—of respondents said they had either never had an independent compliance program evaluation or were not sure when it had been last conducted.
“Those falling in this category should think about having it done, especially if there’s any indication there may be regulatory enforcement interest in the organization,” Kusserow said.
“The spotlight of the enforcement people is looking in your direction. You’d better really focus hard on coming up with an independent evaluation that shows and documents the progress you’ve made in the program. It’s very important,” he added.
Forty percent of respondents said they had their last independent compliance program evaluation within the last three years. And twelve percent said they had done so three years ago.
Document what you have accomplished and look for opportunities for improvement to increase effectiveness.
Said Kusserow, “An evaluation of your compliance program should start with documenting and evidencing your compliance programs to date. Both the OIG and DOJ have said all compliance is a work in progress. They expect you’re going to have to respond to the ever-changing regulatory enforcement and business environment and therefore the program should always be moving forward.”