Paul P. Jesep (pjesep@hhchc.org) is the Chief Ethics and Compliance Officer at Hometown Health Centers in Schenectady, NY. Kristine Pelerin (kpelerin@aol.com) is the Compliance/Quality/Risk/Credentialing Manager at New York Oncology/Hematology in Clifton Park, NY.
This is Part 1 of a two-part article. Part 2 will be published in the October issue of Compliance Today.
Value-based payments and good value for quality healthcare will not only have an enormous impact on the healthcare paradigm, but quality and compliance will evolve in the process. In Part 1, the authors provide an overview of the historical development of quality and compliance and how they’ve complemented the other. Part 2 will address how these distinct yet collaborative areas will further integrate patient care while maximizing every dollar spent.
Quality and compliance have always strived toward comparable goals, although they have distinct applications and developmental histories, especially in healthcare. Sometimes statutorily mandated and quality-fueled approaches have been placed in silos to the detriment of patient care.
As they move to embrace a major shift in the healthcare paradigm, quality and compliance offer new opportunities to build upon each other. Understanding the overlap and their value as partners reveals unexplored opportunities to advance healthcare.
Quality and compliance defined
Quality at its core identifies best practices and ongoing performance evaluation to make improvements. It’s not punitive in nature, which is a widespread, unfortunate perception compliance officers must still grapple with when getting buy-in for their area of responsibility.
Quality demonstrates how benchmarks and measurements enhance patient care. Its data-driven approach excites and empowers healthcare professionals who see positive results firsthand.
Compliance is regulatory enforcement. It involves avoiding penalties. Good-faith missteps by a healthcare organization can still get its activities labeled as “fraud” by a government regulator.
Hence, openness often shown toward quality doesn’t easily transfer to compliance. The former is perceived as making a difference. The latter is seen as punitive and bureaucratic, sometimes defining the tone of a compliance program.
