Establishing Commitment From the Top of the Organization

An important and often overlooked aspect of developing a compliance program is the need to obtain commitment from the top of the organization.  Many times in a physician practice this will mean the physician owners of the practice.  It is important that the physician have a clear understanding of the need and benefit of establishing a focused compliance program.

There will inevitably be initial expenditures involved with establishing a compliance system.  In some cases it may even necessitate retaining additional staff.  There will almost certainly be fees to outside attorneys and consultants if the organization is not large enough to hire the needed expertise internally.  It is important that sufficient resources be allocated to compliance and that the physicians and administration understand that in the long term, these expenditures will pay off by reducing the risk of institutional compliance problems.  The difficulty is that if the compliance program works to reduce risks, there will never be a serious event that proves the benefit of the expenditures.  However, if an event occurs in the future and there is no compliance program in place, the regrets will be very deep because compliance issues are much more difficult to solve if there is no compliance plan in place.

As a practical matter, the institutional “buy-in” is often the most difficult hurdle to overcome.  It is somewhat easier now that compliance plans are becoming mandatory.  Yet there is still risks associated with under-funding compliance activities or providing enough resources to do the “bare minimum” when it comes to compliance due to a reluctant attitude on the part of physician leaders who are now being forced to develop compliance programs that they have not fully embraced.

Certain groups may be in a position that they have not been dependent upon institutions who have implemented compliance programs.  Some practices completely reject policies and procedures of any kind that could bind the physicians in their practices.  These organizations present the greatest challenges and unfortunately the greatest potential risk of violations of federal and state laws occurring due to the low level of leadership embracing appropriate compliance activities.  Even as these groups are forced to adopt compliance programs, they present the greatest residual risk because of a low level of physician commitment.

We suggest that physician practices begin the process of implementing formal compliance programs immediately to provide more time to gain physician commitment and appropriately assess the risks associated with the specific practice.  It takes a great deal of time to develop a system for establishing compliance programs, perform a “gap analysis” or other baseline analysis, perform employee interviews and take other steps to identify specific risk areas.  Developing a compliance program is much more than simply adopting a form compliance program.  Even though the precise effective date that compliance programs will become mandatory for physician practices has not yet been set, providers should consider this time a gift to permit them to develop appropriate policies rather than a reprieve.