While strict healthcare industry laws benefit patients, they can be frustrating for providers. Potential obstacles include privacy and data breaches, inadequate training, changes in the technology landscape, and resource constraints. This guide explores these compliance issues in detail and provides helpful tips to resolve them.
Common Healthcare Regulatory Compliance Issues
The strict legal framework governing the healthcare industry protects patients and keeps the entire sector safe. However, these stringent measures sometimes lead to multiple concerns. Some common challenges that healthcare organizations face with regulatory compliance include:
1. Privacy and Data Breaches
Laws like the Health Insurance Portability and Accountability Act protect patients’ sensitive, private health information. HIPAA requires healthcare organizations to implement solutions to safeguard data, including personally identifiable information. Still, providers reported about 133 million exposed, stolen, or unlawfully disclosed records to the Department of Health and Human Services Office for Civil Rights in 2023 alone. These incidents resulted in significant financial and reputational losses through fines and lawsuits. But the question remains — why such high figures?
First, medical institutions are prime targets for cyberattacks because they possess such valuable information. Second, the data protection strategies implemented often fall short of the required standards. Considering the increased level of risk, practical solutions for mitigating data breaches are essential, such as regularly reviewing access control protocols and monitoring systems.
2. Staff Training and Education
Staff training and education are a legal requirement in most cases. For example, under HIPAA, each new employee must undergo training within a reasonable period after joining the organization. There are also regulations for continued education and training to improve compliance, especially in the following areas:
- HIPAA privacy and security rules
- Patients’ rights
- Allowable protected health information
- Implication of HIPAA violations
Other federal agencies like the Occupational Safety and Health Administration and some state legislation provide added requirements. The training content may differ depending on the circumstances. The regulatory environment’s complexities leave most healthcare workers undertrained.
3. Telehealth
The COVID-19 pandemic brought about sweeping changes in the health sector. One classic example is the prevalence of telehealth. Even after the official termination of the COVID-19 Public Health Emergency on May 11, 2023, Congress is advancing specific telehealth flexibilities through 2024. The primary purpose is to enable Medicare patients to continue receiving authorized services regardless of location.
Telemedicine has become an essential aspect of the healthcare delivery system. However, it has also become necessary to implement more stringent measures to address fraud and other related issues. For example, healthcare providers must execute a mandatory contract with vendors to protect patient health information. This requirement was not necessary during the PHE. Additionally, the expiration of waivers that allowed relief from the anti-kickback statute and Stark law will have immediate implications for medical professionals.
4. Changing Technology Landscape
The healthcare industry has witnessed rapid technological changes. Developments like artificial intelligence and machine learning have improved medical services, enhancing diagnostic accuracy and promoting informed decision-making through predictive analysis. On the other hand, these innovations have also introduced substantial regulatory challenges in healthcare compliance.
AI tools demand a tremendous amount of data to function optimally, which raises concerns about privacy and bias when deploying AI-based solutions or products. As a result, compliance officers and medical professionals should constantly re-educate themselves.
5. Resource Constraints
While medical organizations need additional resources to comply with regulations, most institutions fall short in one or more of the following areas.
- Budgetary: It can be challenging to allocate financial resources to implement and monitor compliance programs. Regardless of the situation, compliance is necessary for successful operation, and organizations must adhere to the regulations.
- Hiring: Adequate staffing with the necessary expertise in compliance is relevant. Nonetheless, high turnover rates and lack of training make it challenging for most healthcare organizations to develop, implement, and monitor effective systems.
- Technology: Healthcare organizations need robust systems and technology infrastructure to effectively manage and monitor compliance activities. However, investing in and maintaining these systems can be costly, especially for smaller organizations with limited IT budgets.
How Can You Resolve Healthcare Compliance Issues?
While some challenges are inevitable, organizations can implement practical solutions to address them. Below are six tips and best practices for mitigating healthcare regulatory compliance issues.
1. Assess Existing Compliance Policies
The first step to resolving compliance issues within the organization is conducting a thorough assessment of the existing policies and procedures. This strategy enables the compliance officer to identify gaps and develop practical solutions. The information you gather from the assessment will become the roadmap for implementing an efficient compliance system.
2. Establish Clear Policies and Procedures
The initial assessment result will give the compliance officer the information they need to develop clear and comprehensive procedures. Policy must align with regulatory demands, industry best practices, and the organization’s values. The compliance team should also review the policy regularly and update it to reflect changes in laws.
3. Conduct Training and Awareness Programs
Each worker must have access to a comprehensive policy and understand their respective roles. No matter how carefully you spell things out, your organization should still provide awareness campaigns and continuous training for all staff members.
4. Enforce Compliance Protocols
Outline the implications of non-compliance and consistently enforce them to deter violations and promote accountability. The compliance officer can establish confidential reporting mechanisms to allow workers to report concerns without fear of retaliation. Promptly investigate issues, address them, and provide feedback.
5. Monitor and Audit Compliance Systems
Proactively monitor and audit processes to detect and address compliance issues. Then, conduct internal audits to assess compliance levels and identify areas of improvement.
6. Outsource to Professionals
Consider seeking external professional support from healthcare experts to audit your policies and develop effective compliance policies. Healthcare compliance officers can also implement new procedures and provide ongoing guidance. This approach benefits large and small medical organizations, especially those with limited resources. Your institution can rely on the professionals’ expertise and technology to improve the regulatory requirements.
Contact DoctorsManagement for Your Compliance Needs
Do you need help with your medical compliance challenges? DoctorsManagement can provide practical solutions tailored to your needs. We are a full-service consulting firm that helps medical professionals mitigate compliance risks. Our team can audit your compliance policy and implement strategies to achieve your goals. Please contact us today to learn more about our services.
