Compliance officers struggle with balance as role grows.
The Affordable Care Act is an overwhelming, enormous piece of legislation with so many moving parts it can be intimidating to even breathe the word compliance without creating anxiety. And it is only going to get worse. Compliance officers are doing more work than ever and their stress levels are intensifying. Some even want (in a way) a Medicare audit at their organizations because their organizations will have little choice but to provide the resources necessary to get a tough job done. While there are varying degrees of opinions as to whether organizations are supportive of the needs of compliance officers, the common denominator is that the job is difficult and becoming more so.
And there are not enough people in compliance and operations to really respond to all of the potential agencies able to audit an organization. Plus there is no clear line where a compliance officer’s role begins and where it ends. Compliance officers have to plunge themselves in departments to help them interpret regulations, solve problems and respond to audits. However, these same compliance officers must simultaneously remain objective and autonomous.
This lack of clarity engenders a great deal of stress for compliance officers. It would be helpful if employees understand that everyone in the organization should be accountable for compliance but that can be troublesome as well. Managers may not believe that a corrective action plan needs to be implemented while the compliance officer knows that it does but is reluctant to report it to the person over the manager’s head. The importance of transparency has never been better illustrated – once compliance plans have a transparent aspect to them, then managers know that their actions are visible to all and subject to explanation and accountability as to why things are not being done.
But there is a fine line to walk: Compliance officers struggle with being taken seriously and not attaining buy-in; they face an innate questioning of internal opinions, i.e., very often external sources are viewed as more credible; and these compliance officers can be perceived as less objective and more and more willing to overstep their boundaries, which allows distrust to grow and spread.
Hence it has never been more essential to solicit the help of people in operations, human resources, audit, legal, risk management and other departments. No one person can audit and monitor billing, physician relationships, privacy, and quality of care as well as conducting compliance-program effectiveness reviews. The development of checklists or audit tools for various departments to administer can be a viable alternative to leaving the onus on one person or one department.
Unfortunately, this is not the easiest task to pull off; executives and board members may not understand the role of compliance officers and compliance programs and large the task actually can be which can leave the compliance department on their own. Additionally, there is an unspoken concern about bringing issues to the compliance officers – a fear of retaliation or worries about losing positions or power, creating a vacuum of little support and no enforcement.
Ironically, the federal government under healthcare reform is holding board members accountable for their organization’s compliance. So the buy-in should be unequivocal. Many compliance officers believe the only event that would affect the current climate is a big audit or an enforcement action. Forcing healthcare organizations to act seems to be the surest way for compliance departments to be validated. Until then compliance officers will continue to push for the adoption of regulatory requirements and ethical standards while proving that their programs positively affects outcomes and reduces risk overall.