Because Medicare Says We Have To…

Recently Hospice Fundamentals saw an internal hospice newsletter and came across a picture of the compliance officer wearing a police uniform with a menacing look on his face. Although meant to be playful, the picture sent a clear message—the compliance officer is an enforcer, someone with weapons and the power to arrest. With a figure like that within the agency, who has time to worry about external threats?

In reality, the role of an effective compliance officer is to help a hospice get to “yes”. Yes to figuring out how to design and deliver care that meets the needs of its community and complies with regulation, yes to navigating complex patient care situations, yes to building an infrastructure that can carry the agency through difficult times.

And difficult times are coming—the writing is on the wall. Or, perhaps more correctly, the writing is on many walls. The Office of the Inspector General, the MACs, the ZPICs and who knows who else. We may not see the Medicare surveyors often but we are surely getting a lot of attention from many other quarters.

But now is the not the time for panic or handwringing—rather it is a time for each hospice to roll up its figurative sleeves, get down to business and take stock of its compliance and quality infrastructure. Where to start? Consider the questions below and then commit to carving some time out of your busy schedule and review the OIG Compliance Program Guidance for Hospices, the OIG Workplan and the OIG Reports on Hospice Care in the Nursing Home (Sept. 2009). Drop us an e-mail if you need a copy of any of them.

Does your hospice have an active, effective compliance program that includes the 7 elements below (translated from the original into plain speak)?

1.  Think through how people should act and write it down

2.  Identify who will be responsible (and accountable) for your compliance efforts; pull together a group to assist

3.  Train people – and make certain that you do it effectively

4.  Make sure you have a way for the important information to flow

5.  Decide what will happen if someone breaks the rules, tell everyone and follow through

6.  Consider risk areas, figure out how to monitor them, make a schedule and stick to it

7.  When you discover a problem, respond to it and figure out what to do to fix it

Do staff members know what to do when they have a compliance related question? Do they actually know when they have a compliance question?

Do you have a process in your hospice to keep current on all the regulatory updates and trends?

Does your QAPI program work to support compliance?

Do you have effective monitors in place? Do you know how to safely conduct an internal investigation? Do you understand the importance of establishing attorney-client privilege?

When you hear “Because Medicare says we have to,” do you just accept that as the answer or do you ask:

·  Who said it?

·  Where and when?

·  Has it been superseded?

·  Are my circumstances the same or similar?

·  Is there another regulatory body with which to check?

·  If Medicare is silent on the topic, do we have a policy that addresses it?