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Learn MoreAs the healthcare landscape continues to shift and evolve, the role of its compliance professionals will be adapting and changing as well. For instance, as healthcare moves away from being entirely hospital based, care types and payment structures will take up more and more of their time.
That’s the perspective of Sheryl Vacca, Senior Vice President and Chief Risk Officer at Providence St. Joseph Health, a $24-billion company with 130,000 caregivers in seven states. Vacca, who began her healthcare career as a nurse at the bedside, now handles oversight for compliance, audit, risk management, and information security.
“What used to be hospital-based services are [going] to lose some of the payment,” Vacca says “Our payers are saying, ‘Enough! Hospitals are costing us too much money. We need to focus on how to deliver care differently.’ Even CMS is changing what will be paid for in the hospital vs. outpatient. They’re setting incentives for providers to go outpatient, and some contracts right now are really draconian. From a perspective of going forward in compliance, it’s going be critical to understand that we are really going to be driven in a different way than what we have in the past.”
“Our revenue streams are not necessarily coming from our hospital-based services anymore,” she continues. “Everyone views those as costly. Look at the ambulatory setting and the growth in ambulatory surgeries and the growth in urgent cares. There are standalone ERs that are able to say because of the kind of facility they are: ‘We will take no Medicare or Medicaid patients.’ And so, it’s profit only. I think there will be more and more of that as we go forward. There’s this balance of needing to care for our communities, and then needing to be able to pay our way so that we will be here to be able to provide services.”
Maintaining compliance as rules and regulations change
The compliance professional will be challenged in all settings because the risks are changing, Vacca notes. Organizations are being forced to innovate faster than they’d like, especially in the often-slow-moving healthcare world, and that means compliance also is moving at a speed that will seem overwhelming at times.
“You have to keep in mind that even though we are moving to outpatient services, some of those are still based on the hospital license,” Vacca explains. “We still have requirements that are applicable that we need to make sure apply—The old-school, hospital JCAHO and all the other surveys that relate to our hospital orientation. Most people who have been in hospitals understand that. We know why it’s happening. We know what we need to do in our culture. But when you move further away from that setting the odds of compliance can go down because a different group of compliance requirements that might apply.”
There will also be compliance situations where the regulatory aspects haven’t caught up to the physical situation. When that happens, Vacca says, the need will be to create consistent standards based on what’s already in place so that proper patient care continues unchanged.
“Do we really have to partner with all of our different risk aspects? The patient care provider, the legal team, audit, compliance? We’re not going be able to be siloed anymore and say, ‘Well, I understand this particular regulation. This is what you must do.’ It really will be us coming together as a team in identifying what the risk is. Is it compliance? Is it legal? Is it reputational? Is it patient care? Then we have to work toward a solution.”
This blog post is taken from a HealthStream Second Opinions Podcast that was recorded recently. To hear Vacca’s full discussion, click here.
About Sheryl Vacca:
Healthcare compliance expert Sheryl Vacca is Senior Vice President and Chief Risk Officer at Providence St. Joseph Health, a $24-billion company with 130,000 caregivers in seven states. Her responsibilities include oversight for compliance, audit, risk management, and information security. Most recently, she served as the system-wide senior vice president for chief compliance and audit officer at the University of California. Vacca has received awards from the Society of Corporate Compliance and Ethics (SCCE) and the Health Care Compliance Association (HCCA).
HealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
View All Learning & PerformanceHealthStream offers performance learning management solutions to help develop your healthcare staff into leaders and reduce turnover.
View All ProductsHealthStream works with healthcare organizations to create engaging and high-quality training videos for your staff and management.
View All ProductsImprove care quality and save money by making informed decisions about your healthcare facility and staff with HealthStream's reporting analytics solution.
View All ProductsHealthStream's proven methods for the improvement and overall engagement of your healthcare staff foster a positive workplace and increase retention rates.
View All ProductsThe leadership development program from HealthStream helps mold your high-potential healthcare employees into proven leaders.
View All ProductsWhen you enact HealthStream's quality compliance solutions, you can do so with the confidence your healthcare organization will meet all standards of care.
View All Quality & ComplianceFulfill compliance requirements with a variety of programs and courseware designed to address critical regulatory requirements as well as educate staff to recognize and mitigate risks.
View All ProductsBy increasing your healthcare staff's focus on quality and safety with HealthStream, they can help to reduce medical errors and readmission rates.
View All ProductsLearn about what HealthStream's healthcare policy management software and how it can help aid your organization efforts.
View All ProductsHealthStream's education helps address diversity, equity, and inclusion within your organization, as well as promoting health equity in the communities you serve.
View All ProductsHealthStream offers professional training and education on how to best optimize your reimbursement process within your healthcare organization.
View All ReimbursementTeach your healthcare staff about the revenue cycle and claim management through targeted training and video tools from HealthStream.
View All ProductsLearn about our advanced resuscitation training solutions. Our solutions are designed to help improve patient outcomes.
View All ResuscitationIn all areas of resuscitation, from neonatal to elderly care, clinical deterioration is a risk that can be avoided with the help of HealthStream's training programs.
View All ProductsNurture the skills of your nurses and medical staff to help mold them into effective leaders with development training from HealthStream.
View All ProductsExpand the decision-making skills and effectiveness of your healthcare workforce with HealthStream's clinical development programs and services.
View All Clinical DevelopmentMake sure your clinicians have the support they need to provide competent care with clinical competency training and development from HealthStream.
View All ProductsHealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
View All ProductsThe suite of healthcare onboarding solutions available from HealthStream aids in nurse retention and improved patient outcomes.
View All ProductsGive your healthcare staff the decision support and skills training they need with the online products available from HealthStream.
View All ProductsHealthStream leverages medical professional development in healthcare by providing staff training programs
View All ProductsLearn more about HealthStream's provider credentialing, privileging, & enrollment solutions for healthcare organizations.
View All CredentialingExperience standardized and centralized healthcare provider credentialing, privileging, and enrollment that is smarter and faster than ever before.
View All ProductsAutomated, web-based provider credentialing and enrollment software for growing medical groups.
View All ProductsNCQA-certified CVO verification services for initial and re-credentialing files in an overflow or full-service capacity for healthcare organizations.
View All ProductsSearch, review, and add providers into the Epic provider master file with our Epic app integration, Provider Validate.
View All ProductsMake sure your healthcare staff can schedule out appointments and work schedules with ease using HealthStream's line of software solutions.
View All SchedulingHealthcare scheduling software designed to optimize staffing requirements & elevate patient care
View All ProductsPrecisely align staffing and needed resources to enable efficient patient flow and high-quality, cost-effective patient care.
View All ProductsHealthStream’s free nurse schedule app, NurseGrid™, is built to help you care for your staff and engage with their specific needs.
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