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3 Ways Contract Management Can Improve Healthcare Compliance121
The Patient Protection and Affordable Care Act (ACA) was signed into law by President Barack Obama in March 2010. The highly debated new law makes significant changes to the delivery of health care in the United States.
The ACA has five central aims:
- Achieve near universal healthcare coverage for Americans through collaboration among the government, individuals, and employers.
- Make healthcare coverage more fair and affordable.
- Improve healthcare quality, while reducing wasteful spending, and increasing accountability.
- Strengthen access to primary and preventive health care.
- Make strategic investments in public health through an expansion in clinical care and community programs (Rosenbaum, 2011).
The ACA, which is over 900 pages in length, is very complex. Implementation has been occurring gradually: some parts of the law have already gone into effect, and full implementation will occur in January 2014. Because of its intricacies, health care providers are struggling to comply with all the requirements of the law. The chance of making mistakes and facing penalties is significant.
The ACA will affect a range of industries, from insurance companies to small businesses. Hospitals will be especially affected, as they are the focus of several of the new regulations. One such regulation is The Hospital Readmissions Reduction Program, which was enacted in 2012 and reduces Medicare payments to hospitals with excessive readmission rates. Another regulation, which goes into effect in 2015, reduces federal reimbursements for hospitals with the highest rates of hospital-acquired infections. Hospitals also have the opportunity to earn bonuses, or be penalized with Medicare and Medicaid payments, based partly on patient satisfaction surveys. (Fiore, 2013).
To achieve its aims, the ACA creates dependencies among healthcare organizations. This requires alignment around policies and procedures, which will allow organizations to work more efficiently both internally, and with other local, state, and federal organizations. Consequently, there must be uniformity and consistency in policies. There is a critical need for hospitals to have the following:
- A centralized database of new and updated policies and procedures, as well as outdated policies for reference when necessary
- Clear communication and team-based training, ensuring that employees understand new and updated policies and procedures
- The ability for relevant external parties to reference an organization’s policies, allowing them to work together seamlessly
- Disciplined and streamlined process management for policy creation that allows collaboration on the creation, approval, and review of policies internally, as well as with other organizations
- A resource library that includes applicable legislation, standards and regulations
There is a great deal at stake for hospitals, but some progress has been made. For example, the ACA funded an initiative that created 26 “hospital engagement networks,” (HEN) designed to work with more than 3,700 hospitals to better coordinate patient care. One HEN has reduced its average 30-day readmission rate among its 450 hospitals from 11.2% in 2010 to 10.2% in September 2012. Part of the network’s success was achieved by providing technical assistance to hospitals, and creating shared policies and best practices among the leaders of different hospitals (The Advisory Board Committee, 2013).
It is clear that with the implementation of the ACA, hospitals have the opportunity to work more efficiently, while saving money and improving the patient experience. In order to be successful, many changes will need to be made, and policies will need to be created and updated to reflect these changes. A software based policy management system has many features that can help hospitals with this transition. First, when it’s time to create, update, and review policies to be sure that they align with the ACA, enhanced workflow features streamline the process. Policy development committees can be created to work on specific policies, and members are kept up to date on their roles and responsibilities. Once the policies are created, users can utilize an attestation feature to indicate that they have read and understood each new policy. After the policy creation and review process is complete, users will have quick and easy access to the policies that guide their day-to-day work, and will be kept updated with any changes.
Additionally, with a regulation resource library, all pieces of the ACA can be imported into the system for reference. A standard linkage feature can link each policy with specific pieces of regulations to ensure compliance. The system can notify administrators when any of these regulations change, keeping the organization accreditation and inspection ready.
The Affordable Care Act is sure to improve efficiency in the U.S. healthcare system by increasing patient safety and satisfaction, reducing costs, and ensuring hospitals’ accountability. This will be done by collaboration among various organizations. However, in order to do these things, hospitals must be systematic and thoughtful. By helping hospitals create and update policies, ensuring their receipt and understanding, and linking pieces of ACA regulations to relevant policies, a software based policy management system can support this transition.
References:
Fiore, K. (2013, June 28). Hospitals Already Feeling ACA Pinch. Retrieved July 23, 2013, from MedPage Today: http://www.medpagetoday.com/Washington-Watch/Reform/40160
Rosenbaum, S. (2011). The Patient Protection and Affordable Care Act: Implications for Public Health Policy and Practice. Public Health Reports, 130-135.
The Advisory Board Committee. (2013, February 28). Is Obamacare working? Hospitals finally see drop in readmissions. Retrieved August 20, 2013, from The Daily Briefing: http://www.advisory.com/Daily-Briefing/2013/02/28/With-ACA-efforts-hospitals-finally-see-progress-on-readmissions
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