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View All ProductsMitigate risk and elevate your quality of care. Improving both clinical and business outcomes starts with a smarter, more integrated approach to regulatory training, continuing education and quality management.
Learn MoreThe regulatory burden faced by organizations across the healthcare continuum is significant in terms of the time and resources involved in meeting requirements. This was made especially clear during a recent webinar, Challenge the Status Quo: Ending the Regulation Training Hunt, from HCCS, A HealthStream Company, that was led by Ben Diamond, Vice President of Compliance Solutions, and Debbie Newsholme, Senior Director of Content Development and Compliance Solutions.
Diamond and Newsholme began the webinar with some statistics about the regulatory burden:
Newsholme spent a significant amount of time focusing on the expanded scrutiny that federal and state governments are placing on the areas of the healthcare continuum that are outside the hospital. She believes this will be an expanded focus and become more intense as time goes by. Some examples include:
Home Health
Newsholme offers that the government now audits a targeted number of claims to establish a benchmark for individual home health organizations. If they identify a high level of claims that are not accurate, then they're going to provide one-on-one education to the provider. According to Newsholme, “It's becoming more and more important that organizations not only have training about their billing processes, but also about what constitutes fraud, and what that looks like from a regulatory perspective.”
Hospice
One of the usual suspects for scrutiny in the hospice environment is eligibility. Typically, regulators are going to ask if a person meet the eligibility to be considered for hospice care. That answer should determine the different levels of care, from general inpatient continuous care to home hospice or respite care. Newsholme singles out long lengths of stays as a red flag and mentioned an example where “patients were admitted to hospice and were still there after a year's time.” That obviously does not meet the criteria for hospice and is likely to draw the scrutiny of the OIG and other governmental agencies.
Nursing Homes, Skilled Nursing Facilities, and Adult Living Facilities
These organizations are drawing scrutiny for quality of care, especially for such purposes as rehabilitation and whether patients are getting the types of care that satisfies the quality measures that they need and deserve. According to Newsholme, there’s increased likelihood for corporate integrity agreements related to skilled nursing facilities that are not meeting even minimum quality of care standards. She added, “In some cases, they were deemed to be providing worthless or unnecessary care. That's an area of very close scrutiny, and actions are being taken against some of these agencies.” Another focus is the medical necessity for therapy and whether a patient meets the criteria for receiving it, whether it is physical therapy, rehab therapy, or even occupational therapy.
Staffing Records and Ratios
Newsholme offers that the OIG has placed a general focus on whether a caregiver has the qualifications and the competencies to be providing the care that they are providing. In other words, if there's a licensure or scope of practice indicator, do the individuals who are providing it meet those criteria? Also, staffing ratios—the number of patients to staff—themselves are very important. In assisted living facilities, the focus is on the quality of care. According to Newsholme, “from the corporate integrity agreement (CIA) perspective, we've seen more and more quality CIAs over the last several years.” Where it used to be more in the terms of fraud, abuse, contracts and arrangements, anti-kickback or stark violations, or illegal transactions, now there's just as many quality of care issues that are being investigated.
Learn more about HCCS Compliance training solutions.
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 ProductsImprove the preparedness of your staff, increase survival rates, and cut costs with the advanced resuscitation training services from HealthStream.
View All ResuscitationNurture the skills of your nurses and medical staff to help mold them into effective leaders with development training from HealthStream.
View All ProductsIn 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 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 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's solutions allow your healthcare workforce to be confident and competent with the knowledge they are upholding the highest of standards.
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 ProductsDelivers everything you need to request, gather, and validate information about a provider to create a single source of truth for downstream processes.
View All CredentialingMake sure your healthcare staff can schedule out appointments and work schedules with ease using HealthStream's line of software solutions.
View All Scheduling & Capacity ManagementNurseGrid and Keener - HealthStream's mobile apps built by nurses, for nurses - help nurses take control of their schedules, practice self-care, and build a more sustainable career.
View All ProductsTake the stress out of scheduling with real-time technology that engages nurses and healthcare workers from HealthStream.
View All ProductsProvide an easier way to view healthcare staff capacity insights while seeing a patient’s journey with HealthStream’s operational intelligence and machine learning products.
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