Reversing Conventional Thinking About Compliance  

Reversing Conventional Thinking About Compliance 

“I solve problems you don’t know you have – in ways you may not always understand.” –Unnamed Compliance Officer, in a recent meeting with me  

In my lengthy career in both insurance and healthcare, I’ve met literally hundreds of compliance professionals. No matter who they are, where they live, how much experience they have, or anything else, they’ve all felt the same way about their role within their organization. It’s summed up beautifully by the above quote.   

Generally speaking, compliance professionals feel undervalued in comparison to others around their organization. They also think their leaders and revenue cycle colleagues don’t really understand what they do. It’s sad but true: in a world where a lot of healthcare professionals think of compliance as the “department of no,” or “where good ideas go to die,” these phrases tend to become self-fulfilling prophecies.  

Of course, anyone who really understands compliance knows these statements couldn’t be further from the truth. So how do we reverse this thinking, and elevate the level of understanding and credit that compliance receives for the invaluable work it does?  

Conventional Thinking About Compliance  

It all starts with understanding the prevailing schools of thought among healthcare executives. Of course, healthcare leaders are fully capable of understanding the value of compliance – they just don’t. This is probably because of two reasons.  

First, leaders often observe that their organizations aren’t penalized by regulators or otherwise in trouble. As a result, they wonder why they need a compliance department – why support a function that doesn’t seem to have much to do? Of course, they fail to realize that it’s exactly because of compliance that their organization doesn’t have those problems!  

Second, healthcare organizations are hard to run successfully due to financial constraints, the recent pandemic, staffing shortages, and more. As a result, executives tend to spend most of their time and energy on disciplines and other “squeaky wheels” that are directly tied to revenue production. Compliance, unfortunately for us, tends to be deprioritized in favor of other pressing business issues.   

medical fraud

Ways to Prove Compliance’s Value  

Compliance pros and departments can prove their value to their colleagues and leaders in a variety of ways. They include:  

  • Educating leaders and colleagues about the OIG’s Seven Fundamental Elements of an Effective Compliance Program. These have guided compliance pros for years, but they usually don’t mean much to others around the organization – especially executives. Compliance pros can show how these elements manifest in everyday operations and describe the consequences that could result if organizations neglect them.  
  • Aligning more closely with revenue cycle colleagues. In the same way compliance pros educate others around the organization, they especially need to ensure revenue cycle understands the importance of compliance – and the tangible value it creates. Organizations are better off when these two functions work together to create positive compliance cultures.  
  • Tie compliance’s work to non-revenue metrics that executives care deeply about – such as time and risk. Show how much time (and money) a compliance team saves the entire staff – and the executive team – because they handle issues and solve problems for them. Also, cite examples of similar organizations that might be having regulatory trouble. Add up the expenses and cycles they incur to resolve those situations and use that data to quantify the downside risk that exists. This also shows the competitive advantage you’re creating for your organization by operating properly from the beginning.  

The most successful compliance professionals find ways to prove the value they create. This is how they receive the mindshare and resources they need to do their work well and continue to deliver value to their organizations.  

An Example of Establishing Value  

Take Lisa Herota and her team at Vail Health in Colorado, for example. In 2019, Vail’s CEO challenged the compliance team to find and implement a solution to manage and ease the administrative burden of regulatory change management. More specifically, he wanted the team to more proactively stay compliant with the many regulatory changes it experienced without adding labor or burning out the staff it already had.   

Since implementing that solution, Lisa and team have seen a massive impact in a short time. The first time she presented reports that demonstrate and quantify her team’s handling of regulatory change to her board, they grasped the significance of what the department does and the impact it has. They credit the compliance team’s success as being a significant driver in the organization’s exponential growth in new service areas. They also are about to launch a board-level Audit and Compliance Committee to oversee and support the work that Lisa and her team do.   

Compliance’s value in a healthcare organization, just like any other operational function, derives from others understanding what it does. Executives and boards usually only hear about compliance when things go bad – which is exactly why they should invest in the proper compliance team and resources in the first place.   

Let’s use the tools of our trade to initiate a different discussion with our colleagues and show them what we really bring to the table. Let’s help them do what we do best: solve problems and mitigate risk.   

Jerry Shafran

Jerry Shafran is the founder and CEO of YouCompli. He is a serial entrepreneur who builds on a solid foundation of information technology and network solutions. Jerry launches, manages, and sells software and content solutions that simplify complex work. His innovations enable professionals to focus on their core business priorities.  

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