Purvi Shah Khare (kharep@aimspecialtyhealth.com) is Regulatory Compliance Manager at AIM Specialty Health, a subsidiary of Anthem Inc., in Chicago, IL. Sarra O. Reichwald (sreichwald@rosecrance.org) is Vice President of Excellence and Innovation, and Kristin N. Rice (krice@rosecrance.org) is Performance Improvement Compliance & Training Specialist at Rosecrance Health Network, Rockford, IL.
“Because the law says so” has never been the most successful reasoning tool a compliance professional can whip out when guiding a team on a compliance-related matter. The role of the compliance department in any healthcare organization is dynamic, multifaceted, and complex. We are traditionally responsible for being the surveyors of fraud and abuse, overseeing audit functions, ensuring appropriate policies and procedures are in place, and serving as the organization’s moral compass. But how do we reach others within the organization? The answer is through education and guidance, both formal and informal. Yes, we must develop trainings or at the very least ensure proper formalized training is available and tracked for all staff to proactively maintain compliance.
However, the compliance professional is also traditionally tasked with providing education informally. A member of the compliance team is often invited to be the poker of holes and the human-form reminder that an idea may be more intricate than originally thought. There may be a regulatory question or the need to vet a new idea, whether it is a new service line, change in process, or a current compliance issue that must be addressed. Companies depend on the compliance team to come to the table to ask questions, voice concerns, and confront the brutal facts. The compliance department must remain friendly and empathetic, although at times it must be the bearer of bad news regarding regulatory requirements and legal or ethical constraints.
Our roles require collaboration and integration for the company to succeed with new initiatives, process improvements, and in analyzing risk management issues affecting the various service lines of the organization. It is imperative for the healthcare compliance professional to form strong relationships with leaders throughout the company, whether they are operational directors or are in other areas of expertise such as human resources, IT, medical records, marketing, or finance. Developing trusting relationships with colleagues and employees throughout the organization allows for a more collaborative environment to openly share ideas, have healthy debate, and reach the best responsive steps and resolutions for the service provider and its patients.
