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H OW M ANY B ALLS C AN Y OU J UGGLE ? Issues Relating to Integrating Compliance Practices for Multiple Entities National Congress on Health Care Compliance.

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Presentation on theme: "H OW M ANY B ALLS C AN Y OU J UGGLE ? Issues Relating to Integrating Compliance Practices for Multiple Entities National Congress on Health Care Compliance."— Presentation transcript:

1 H OW M ANY B ALLS C AN Y OU J UGGLE ? Issues Relating to Integrating Compliance Practices for Multiple Entities National Congress on Health Care Compliance February 7, 2002 Grand Hyatt Hotel Washington, DC J OEL D. D ZIENGIELEWSKI Kaiser Foundation Health Plan, Inc. R OBERT C HING Hawai`i Pacific Health

2 L EARNING O BJECTIVES Overview of those factors which will impact your ability to juggle any balls and, therefore, your ability to integrate compliance practices Overview of potential strategies to address and overcome those factors

3 A GENDA lBackground information lFactors impacting integration of compliance practices lStrategies to integrate compliance practices

4 B ACKGROUND I NFORMATION lSize of your organization lMultiple locations lRecently acquired or acquired another lLength of experience in your job

5 I NVITATION TO J UGGLE lIndustry economics lEfficiencies and synergies

6 T YPES OF I NTEGRATION I SSUES lCorporate organization issues –size and nature of the integrated entity lCompliance leadership issues –accountability and structure lStrategic planning issues –federal sentencing guideline elements lTechnology issues –IT capabilities and practices

7 C ORPORATE O RGANIZATION I SSUES lCorporate dynamics –number of employees and physicians –geographic dispersion –resources –labor vs non-labor lStrategic planning issues –corporate culture –legal parameters –financial considerations

8 C OMPLIANCE L EADERSHIP I SSUES lCompliance program history –executive leadership commitment –compliance organization –compliance history lCompliance accountabilities –business practice model lCompliance issues –beyond fire drills –risk analysis

9 S TRATEGIC P LANNING I SSUES lCompliance program elements ècompliance program ècode of conduct ècompliance committee ècompliance training èconfidential disclosure program/hotlines èscreening of ineligible individuals

10 T ECHNOLOGY I SSUES lIT capabilities and practices –IT solution potential –integration into practice lIntegrating multiple systems –billing, coding, and CDMs –common platforms –inefficiencies of scale

11 D ETERMINING W HICH B ALLS TO J UGGLE “B OWLING B ALLS” VS. “R UBBER B ALLS” lDue diligence process lCorporate integrity agreements lCorporate imperatives

12 S TRATEGIES FOR I NTEGRATION lDetermining the size of bowling balls –prioritize by risk –resource limitations –picking your battles lJuggling bowling balls –assumption of efficiencies –consolidation vs. effectiveness –experience

13 O NE P OSSIBLE A VENUE TO S UCCESS... lA framework that promotes the establishment of a system lA cohesive comprehensive plan that will support the development and continuity of a system

14 E VOLUTION TO A C OMPLIANCE S YSTEM 7 Element Development Specialized Training Risk Assessment / Monitoring Set Operations Accountabilities Infrastructure Development Code of Conduct Conflict of Interest Survey Compliance Hotline General Compliance Training Policies & Procedures Completion Will Be Heavily Dependent On OPERATIONS Personnel Completion Will Be Largely Dependent On COMPLIANCE Personnel

15 S EVEN E LEMENT M ODEL P ROVIDES F RAMEWORK lCode of conduct lCompliance help line lCompliance processes - conflict of interest, etc. lGeneral compliance training lPolicies & procedures lRisk assessment - AND - Corrective actions lSpecialized Training Rinse & Repeat ……..It Never Ends…...It Becomes Embedded…...It Becomes Less REACTIVE

16 F ACTORS A FFECTING P LAN D EVELOPMENT E XPERIENCES FROM THE F RONT L INE lCorporate organization issues –size and nature of the integrated entity lCompliance leadership issues –accountability and structure lStrategic planning issues –federal sentencing guideline elements lTechnology issues –IT capabilities and practices, functional vs compliance

17 F ACTORS A FFECTING P LAN D EVELOPMENT REPAYMENT REACTIVE =REPARATION REPUTATION OR PROGRESS PROACTIVE = PROTECTION PROMINENCE

18 C ONCLUSION QUESTIONS


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