Compliance is expensive. An article in the March–April 2020 issue of Harvard Business Review refers to “the staggering amount firms spend on compliance efforts… to prevent and detect violations of laws, regulations, and company policies.” Depending on a company’s size and footprint, the authors point out, it could spend several millions of dollars annually on compliance, and highly regulated industries such as financial services may need to spend many times that amount.
But such sums can seem paltry compared to the cost of noncompliance—and perhaps nowhere is this truer than in healthcare. Healthcare institutions must comply with a myriad of federal, state, and accrediting body regulations. Penalties for noncompliance are steep, in terms of fines and reputational damage. Consider the case of a large healthcare system in the Midwest, which in 2018 settled a case for $84.5 million to resolve allegations under the False Claims Act related to physician compensation. Such fines are no longer always insurable, and healthcare executives may even be held personally liable when significant gaps in oversight are discovered.
In the hypercompetitive healthcare arena, no institution wants to see its name in the headlines above a story detailing corporate malfeasance. It’s not good for physician recruiting, and it’s not good for attracting new or returning patients either.
Despite the threat of such fines and the concomitant damage to their reputations, many healthcare organizations are so focused on operating margins and driving supply chain efficiencies in a pandemic environment that high-risk compliance areas, such as their physician compensation structures, are often overlooked. Physician contractual relationships tend to grow organically over time with changes to how physicians are paid, including compensation for additional duties they’ve agreed to perform.
An analysis published by Crowe, a public accounting, consulting, and technology firm, summarized assessments of 3,000 risks across more than 250 hospitals, health systems, physician practices, and other entities in 2019. The top compliance challenges facing hospitals were physician contracting, non-physician contracting/supply chain agreements, and compliance with the Health Insurance Portability and Accountability Act (HIPAA). Lack of preparation for these and other risks “can cost a healthcare organization money and its reputation at a time when it can least afford to lose either,” the study said. “Early identification is the best strategy to mitigate those risks.”
The struggle to stay compliant
Because of constantly changing healthcare regulations, hospitals and health systems struggle to stay compliant. This is one reason we developed a Compliance Suite, integrated with our contract lifecycle management platform, to address potential compliance risks. Here are just a few of the regulations governing a health system’s contractual relationships:
• The Anti-Kickback Statute prohibits the knowing and willful payment of “remuneration” to induce or reward patient referrals or the generation of business involving any item or service payable by federal healthcare programs.
• The Stark Law prohibits physicians from referring patients to receive “designated health services” payable by Medicare or Medicaid from entities with which the physician or an immediate family member has a financial relationship, unless an exception applies.
• HIPAA requires that healthcare suppliers who exchange Protected Health Information (“PHI”) must have a Business Associate Agreement (“BAA”) in place to protect patient privacy.
TractManager’s automated tools track, monitor, and report on compliance-related headaches associated with conflicts of interest, physician compensation, BAAs, and other risks before they happen
“TractManager’s automated tools track, monitor, and report on compliance-related headaches associated with conflicts of interest, physician compensation, BAAs, and other risks before they happen,” says Mark O’Connor, Senior Vice President, Product Strategy & Growth.
The solution for compliant contracting across the hospital organization or system starts with impeccable processes that are built into the contract creation and management workflow. The ability to manage all stages of the contract lifecycle process— contract origination, negotiation, agreement of terms, signature, storage, ongoing management, search and retrieval, auditing and reporting, and, finally, renewal or termination—is paramount.
TractManager’s MediTract CLM provides the all-encompassing, integrated platform to manage and support the complete contract lifecycle. MediTract owns the only patented, healthcare-specific CLM platform in the market today. Based on more than 20 years of client feedback across 2,000 implementations, the system is designed to support the specific challenges associated with hospital contracting and compliance.
Compliance Suite eases the burden on organizations
Extending the capabilities of MediTract CLM is a practical Compliance Suite. This solution simplifies data gathering, activity monitoring, and compliance reporting, so organizations can evaluate and manage vendors and associated compliance risks (Pulse Check Vendor Surveys); track provider time reporting (Provider Time Tracking); identify and avoid conflicts of interest (Conflict of Interest Capture); and record gifts or other non-monetary compensation (Gift Alert). TractManager’s Compliance Suite was designed and is supported by healthcare compliance experts to simplify and manage the complex regulatory demands of healthcare contracting.
Another area of regulatory risk is found in the management of provider contracts. TractManager’s Provider Management solutions streamline and accelerate provider contracting, credentialing, privileging, enrollment, and ongoing management functions, increasing productivity and eliminating delays in revenue capture. Clients can manage all their provider onboarding functions in-house using TractManager’s credentialing software—and can also outsource the process to our team of experts.
TractManager’s technology— developed over more than 30 years by and for people in the healthcare industry— combines contract management, compliance, and provider management capabilities into a unified system. The payoff: healthcare professionals can worry less about regulations and concentrate more of their energies on delivering excellent patient care.