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Learn MoreThe first updates to the Office of the Inspector General (OIG) General Compliance Program Guidance (GCPG) in nearly 30 years took effect on November 6, 2023. While the guidance does not create new laws or legal obligations, the GCPG does modernize the original OIG guidance and makes it more accessible.
It should also be noted that there is more to come. This release is specifically directed to federal healthcare providers, but it will likely be followed by industry-segment specific CPGs (ICPGs) with the next areas of focus expected to be managed care plans and skilled nursing facilities. It is anticipated that the next round of guidance will be available in 2024.
The GCPG provides information about relevant Federal laws and acts as a reference guide for the healthcare compliance community and other healthcare stakeholders. The GCPG provides guidance for hospitals, home health agencies, clinical laboratories, third-party medical billing companies, durable medical equipment and supply companies, hospices, Medicare Advantage plans, skilled nursing facilities, physicians, ambulance companies, and pharmaceutical manufacturers. The GCPG offers voluntary guidance that discusses general compliance risks and programs. The GCPG is not binding on any individual or entity.
What follows are some highlights from the recent updates.
The new guidance recommends that compliance programs include quality and patient safety within their scope. This has been an often-discussed topic in healthcare compliance; however, many compliance programs still do not include quality and patient safety. The OIG now recommends that healthcare organizations include quality and patient safety in their compliance programs to provide more insight into quality and patient safety issues and to help the organization reduce the risks associated with incidents resulting in patient harm.
In addition, the new guidance recommends that compliance committee members receive regular reports on quality and patient safety issues as well as information on the adequacy of patient care. It also recommends establishing and implementing a regular process for performing quality audits, including an assessment of if staffing levels are sufficient to reduce risk and ensure patient safety. The OIG recommends risk assessments be conducted annually and that the Compliance Committee be responsible for the audits, rather than the Compliance Officer, in order to better demonstrate an organizational focus on these issues. In addition, upon the completion of the audit, it is recommended that findings be reviewed and used to develop an action plan to address the findings.
The OIG has emphasized that compliance is completely voluntary and not binding on individual organizations. In addition, it offers resources that are designed to be flexible regardless of the size of the healthcare organization. A section of the GCPG update is devoted to ways in which the compliance program can be “right-sized” to the needs and size of any organization and even recommends specific strategies that will help all organizations implement the guidance. The additional focus on right-sizing compliance programs to meet the needs of the entity is helpful for compliance departments when assessing and prioritizing resources and budget requests.
The new guidance includes links to a wide variety of compliance resources. The U.S. Department of Health and Human Services (HHS) OIG’s official release of the new guidance includes an entire section of helpful, free resources. Resources include compliance toolkits, advisory opinions, healthcare fraud and enforcement standards, recommendations for your compliance program’s infrastructure, provider compliance training and more.
While the OIG provides resources in support of this new guidance, the process of building a culture of compliance is an evolving process with many moving parts. HealthStream has compliance solutions that can help your organization build a culture of compliance that prioritizes clinical quality and safety while satisfying federal requirements.
HealthStream can help support your compliance program with innovative technology, adaptive learning, and organizational management tools. The compliance education tools can identify any gaps in compliance and assign a personalized employee learning program to address the gaps with engaging content. HealthStream also provides reporting on course completions and proficiency. Contact HealthStream today to learn more about the tools that can help your organization build a culture of compliance.
HealthStream’s learning management system and healthcare training solutions support medical training initiatives and allow for 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 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 & ComplianceBe confident in your staff’s ability to reduce risk by providing compliance training that changes behavior.
View All ProductsDevelop next-level people for next-level care by prioritizing quality and safety improvements.
View All ProductsEstablish a culture of belonging with education supporting DEI, wellness, engagement, and leadership development.
View All ProductsUtilize patient access solutions and advanced reimbursement solutions to manage clinical denials and improve your organization’s reimbursement strategy.
View All ReimbursementExpand the decision-making skills and effectiveness of your healthcare workforce with HealthStream's clinical development programs and services.
View All Clinical DevelopmentLearn about our advanced resuscitation training solutions. Our solutions are designed to help improve patient outcomes.
View All ProductsOur competency development solutions personalize learning for clinicians to bridge the gap between theory and practice for your nurse residents.
View All ProductsEnhance maternal & child nursing care with solutions focused on improving the quality of care for mothers, infants, and children.
View All ProductsAddress staffing orientation challenges to easily achieve and maintain certification with our emergency and acute care training solutions.
View All ProductsAs a premier provider of healthcare education, we are committed to promoting safer, more successful surgical and sedation outcomes for each and every patient.
View All ProductsOur solutions are designed to cater to the needs of patients, healthcare professionals, and organizations dealing with illnesses or chronic conditions.
View All ProductsOnline clinical placement software allows schools, healthcare organizations, and students to seamlessly manage clinical and nursing rotations.
View All ProductsComprehensive, industry-leading provider onboarding and credentialing software that validates health outcomes and supports provider assessment.
View All CredentialingOur affordable CVO credentialing services establish patient safety by enabling primary source verification for your healthcare organization.
View All ProductsIntegrate with Epic to validate and add new providers directly to your provider master file.
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 workforce management is essential. We provide advanced scheduling solutions for organizations to solve issues such as nurse retention
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