Changing the landscape of hospital business

How are the financial regulations associated with the Affordable Care Act changing the landscape of hospital business offices?

Silos are out, committees are in and compliance officers just might be finding a more central seat at the executive conference table. 

With the need for heightened cost containment, healthcare organizations are finding their billing drastically more complicated, said Jeff Loughlin, of the Massachusetts eHealth Collaborative, which coordinates the development of electronic health record networks. 

"Coordination is becoming much more important," Loughlin said. "Looking at all the ACOs from the payment-reimbursement side of the industry, from the treatment side, driving toward cost-containment means you need to coordinate all the efforts at a larger institution that are driving toward more efficient care."

Whereas large hospitals have long had compliance officers, there is a heightened demand from smaller organizations on job boards. Loughlin said that's a sign that smaller hospitals now see a need for a central point of coordination.

In the past, regulatory demands might have been parsed throughout the executive suite, with the chief medical officer, chief nursing officer, general counsel, auditing, compliance and CFO all tending to respective regulatory issues.

Under the ACA, two realities are forcing changes. 

First, the use of electronic medical records shortens timelines. Digital data collection ostensibly makes compliance monitoring easier, provided the monitoring itself is done in a way that's compliant with regulations.

"All this needs to be happening in more of a real-time, interoperable fashion," Loughlin said. "We're seeing hospitals building these much more collaborative groups of C-level or senior-director level that has people talking directly."

Second, making compliance a higher priority saves money in the long run.

"There's a reason healthcare is one of the most fined industries in the history of planet Earth," said Roy Snell, the CEO of the Health Care Compliance Association and the Society of Corporate Compliance and Ethics, which together total more than 10,000 members. "When it's come to making sure we follow the rules, we haven't done a very good job of it."

Snell said that in the past, new regulations would create "a whole bunch of commotion about what we're supposed to do, but no proper follow-up to ensure we actually do it. Compliance officers take a comprehensive, operational approach to following through."

Snell sees the industry moving in the right direction. 

"More people are in meetings," Snell said, "and more problems are being prevented before they become multi-million dollar public relations nightmares."

Real progress will come when executives better understand the role of the compliance officer, Snell said. Confusion remains over the difference between the work of compliance staff and, say, audit, legal or human resources staff. 

"The difference is in the follow through," Snell said. "Compliance staff help put policies in place to make sure problems are prevented, found and fixed." 

The role of the compliance officer at the C-suite level, Snell said, is to ensure strategic initiatives can be executed in ways that are in compliance. Not doing so only invites trouble.

"It would be like building a building without having an engineer involved," Snell said. "When making major decisions about your business, it's just smart to have an expert in the room that knows all the rules and factors."