MH: Compliance programs in public entities are very different from nonpublic entities in many ways and very similar in other ways. Can you tell our readers about your background, your current position at San Mateo Medical Center (SMMC), and how you developed your compliance program to address the unique risks for a public safety net hospital?
GB: I started my career focusing on public interest law and health policy, and then transitioned to working on the rollout of the Affordable Care Act. I was a new lawyer who was passionate about expanding healthcare access to underserved communities. I started working for county government during that time, and then an opportunity arose to work at SMMC doing privacy and compliance work. I thought it would be the perfect opportunity to combine my legal background with working on the frontlines of healthcare access in our community.
I also grew up in a healthcare family—both my parents are family physicians who have worked for public healthcare systems and hospitals their entire 35-plus-year careers. My dad has worked for another county hospital in California for the last 27 years, so I have been immersed in healthcare at the county level since I was a child.
When I started at SMMC in 2017, the existing compliance program had spent the last few years building up specific metrics, such as training, targeted audits, and Office of Inspector General exclusion reviews. Since then, one of my biggest goals has been to become an integrated member of our revenue cycle team so that together we can continuously monitor compliance and evaluate risk. As a public healthcare system, we are much smaller than other Bay Area systems, and therefore I work closely with our operational managers to emphasize the importance of financial and regulatory compliance in their departments.
MH: Tell us a bit about SMMC and the services you provide to the community. How is the compliance department structured to address the risks these services may pose, and how do you collaborate with others in the organization?
GB: SMMC provides both clinical and hospital services. We have more than 200,000 clinic visits a year. Contrast that with our just over 31,000 inpatient days and 41,000 emergency department visits a year. Additionally, SMMC is a federally qualified health center, the patient population of which largely has Medi-Cal as their insurance provider. As a safety net healthcare system, we serve some of the county’s most vulnerable residents—often those with chronic conditions and a wide variety of social and economic challenges.