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Blog-Ensuring Compliance-V2

Ensuring Compliance With Regulatory Agencies

March 16, 2022
March 16, 2022

Healthcare regulation is intended to ensure that patients receive safe, high-quality care. Federal, state and local regulatory bodies are tasked with protecting healthcare consumers, providing safe work environments for healthcare providers and regulating reimbursement as well as ensuring that public health initiatives are carried out. Regulators also may be responsible for establishing and enforcing penalties for non-compliance with these regulations.

Regulatory Compliance in Healthcare

One of the challenges of regulatory compliance in healthcare is that there are a rather large number of agencies regulating various aspects of healthcare at the federal, state and local levels. In addition, there are other agencies, usually accrediting agencies, with whom participation may be voluntary (and also quite valuable) such as Joint Commission and the National Committee for Quality Assurance (NCQA).

Among others, healthcare organizations are regulated by:

  • The Centers for Medicare and Medicaid Services (CMS) – CMS provides government-subsidized medical coverage through Medicare, Medicaid and Children’s Health Insurance Programs (CHIP). CMS also regulates compliance with the Health Insurance Portability and Accountability Act (HIPAA) which protects patients from having their private health information shared without their consent.
  • Agency for Healthcare Research and Quality (AHRQ) – AHRQ is an agency of the Department of Health and Human Services (HHS) and conducts research with the goal of improving patient safety and outcomes and reducing healthcare costs.
  • Centers for Disease Control (CDC) – The CDC collects and analyzes public health data and works closely with international health agencies to monitor and control the transmission of disease.
  • Food and Drug Administration (FDA) – regulates and monitors the safety of food and drugs as well as the nation’s blood supply and medical devices.

It is impossible to name an aspect of healthcare that is not covered by some sort of regulation, which makes compliance perhaps one of the most significant challenges for healthcare leaders. 

Regulatory Compliance – Why it Matters

Regulatory compliance matters because the stakes in virtually every aspect of healthcare are high. They are high for patients, providers, healthcare organizations and consumers. A great deal of healthcare regulation deals with issues relating to patient safety where the stakes are perhaps the highest. Compliance with healthcare regulations ensures that providers follow the kinds of procedures that will result in safe and effective patient care.

Healthcare providers and organizations that are not in compliance face censure that can range from significant fines, the largest of which could be in the millions of dollars, and sanctions that can include the loss of license or accreditation. They may also face lawsuits, the loss of their ability to contract with payors and the financial repercussions of the bad publicity that may accompany a well-publicized case of non-compliance.

Navigating Regulatory Compliance

In order to keep pace with everything on the regulatory spectrum, healthcare organizations need a compliance plan that addresses federal, state and local regulatory and accreditation issues. Creating a plan that addresses all regulatory and accreditation requirements is an enormous task and requires ongoing auditing and monitoring to ensure that risks to patients, providers and organizations are minimized.

HealthStream’s solutions focus on:

  • Ensuring that the full spectrum of requirements are met: Given the large number of local, state and federal regulations, one of the biggest challenges to regulatory compliance is simply staying abreast of all of the
  • requirements including requirements on training and education. HealthStream has a centralized, continuously-updated database that can make managing this process efficient and effective.
  • Mitigating risk: HealthStream’s Compliance Education helps organizations to mitigate risks and avoid penalties and fines. The content is engaging and the process is efficient, giving credit for existing knowledge and focusing on training that is relevant to the individual learner.
  • Building an effective process for compliance: HealthStream’s solutions use innovative technology, adaptive learning techniques and reporting tools that help healthcare leaders assess the organization’s compliance.