Healthcare Compliance Consultants – Why you might need one & how to pick the right one.

With the Affordable Care Act going into effect, the sheer number of hospitals, insurance companies, and other healthcare providers, that have struggled to successfully implement major changes in their working – without assistance – has increased drastically. Before that, most of the physicians were comfortable in their working. With the major reforms looming; many doctors decided to join hospitals, and by default – leave their private practice. If only they approached the correct issues by hiring the right team, or even the right person, everything would have been different. This is where a healthcare compliance consultant becomes the most useful.

Healthcare compliance consultants can notice the full potential of a practice, a hospital, or any other health facility. They base their strategies on data analysis, knowledge, professionalism, and dedication – while showing the right way to an efficient, low-cost working. Therefore, many healthcare providers since have decided to hire a healthcare compliance consultant.
The global healthcare consulting market is constantly growing. With a value of over $6 billion in 2014, the market amounts to 7% of the whole healthcare consultant industry. With the aspect of further growth, especially in the U.S. – which holds almost two-thirds (62%) of the whole $6.33 billion because of the reforms – the competition in the field is also rising. Meaning, finding the right consultant, whether an individual or an agency, can be challenging.

What to Look for in Healthcare Compliance Consultants

Due to the consultant’s high level of importance to their client, one might ask – what should you even begin to look for in a healthcare reform consultant? My first response to that question is knowledge, this is essential. You need an individual or a team that understands the emerging healthcare market. Reliable consultants have the tools to monitor trends and factors that influence the industry. They depend on data, but still develop their own view of the way the entire system functions. An independent thinker will always understand things better than anyone else. Look for someone that has a unique point of view. It can be wise to test the person’s or the team’s knowledge by having them around for a while. It is a small investment, but it will eventually pay off. Look for someone that will blend with your team and will be interested enough to see what’s beyond the medical practice. These individuals develop suitable strategies that will help you save, improve your management, and teach you how to stand on your own feet. Always look for a well-educated, experienced person. In the healthcare compliance consulting field, a Bachelor degree is the minimum criteria. In case you decide to hire a consultant company, inform yourself on their latest successful projects. Evaluate their views, approaches, and values. It is important for the company to invest in professional development and growth. Getting references can be helpful during the evaluation. However, consultants only show their success. Digging a little bit deeper, for example, spending time in networking can reveal some unexpected information.

Secondly, look for experience. In consulting, the power of experience can’t be underestimated. Many companies don’t include individuals with a minimum of 10 years of experience as their team members. While the size of the consultant company doesn’t make a huge difference, many years of experience are an advantage in solving big projects.

Finally, you must take into account the overall efficiency of your new consultant.The right consultant will have backup plans, but still get manage to finish the project on time. Simply because the team has failed to finish a project in a timely manner before; doesn’t mean that you should hesitate to hire another consultant now. Additionally, an efficient consultant will approach the problem with long-term goals in mind, offering quality work that will stay with your practice, even after the project is officially over. They will provide you with the necessary guidance that will help you manage your practice in a more profitable and efficient way.

Benefits that come from having the right consultant on-hand.

Now as you could imagine, there’s a vast amount of benefits that can come from having a consultant on your team throughout the healthcare reform and implementation processes. First and foremost, the overall easier managing of large projects is one of the main benefits that’s noticeable almost right away. Have you ever tried to fix a problem without a success? With the consultant’s management skills and technical expertise, your project has higher chances to succeed. It is of great value that a consultant develops a strategy by finding the causes of the problem. They will focus on the major issues that need to be solved and by making the project a priority, you will maintain profitability and improve patient service. The consultant is an outsider. Sometimes the issues you might not know you’ve had, will be revealed by a person that is not familiar with the situation and has a clear point of view. Meaning, you need an individual or a team that will commit and spend their time focusing their attention on a particular field.
The second benefit is huge: the increased ROI. The initial cost of the consultant won’t overweight the saving that you will make in the long run. Consultants develop an in-depth strategy that includes all your costs, research on your competitors, measures that you can take to save, and much more, that contribute to organized, effective, and improved practice. Keep in mind that bringing your practice to that level requires an individual or a team that is able to see the flaws and propose an efficient approach.

Watch your practice grow exponentially.

As well, you begin to learn how to run a practice as it is – a business. Many physicians and hospitals are dedicated and focused on providing the best medical service to their patients. Usually, they don’t think of running their practice as a business. This brings them to the point when they face many problems and hope to solve them on their own, or with a help of their team. Eventually, they realize that their team can’t solve all of those problems. Dealing with a complex issue that requires dedication, plan, and analysis can’t be solved by a non-expert team in the field. Healthcare consultants have the required tools and a team that not only will help you solve your problem, but understand the operating and management your business needs.
Next, you will save time figuring out everything by yourself. Implementing planning strategies in your practice is not your expertise. Even if you think you know the best way to run your business, trust me, there is someone that is much better. Spare yourself of all the struggles. You will save time, energy, and money. And save your team the extra effort of figuring everything out. Let them do what they do best. Serve your patients.
In conclusion, you will also improve the quality of your services and operations. Healthcare compliance consultants pay attention to every detail in your practice. They collaborate with your team, developing a new way to improve everyday operations, which leads to the final goal – helping patients. By improving the quality of your overall working, you have higher chances to reduce medical errors, improve patient safety, improve staff, and create a safe environment. Healthcare compliance consultants provide a plan with realistic goals for your organization, set a reasonable deadline, and finished the project successfully. They are well-informed, knowledgeable, innovative, and great leaders.


Regulatory Compliance

Regulatory Compliance – How Does it Affect Your Practice?

Within the ever-changing landscape of the healthcare industry, new rules and regulations to protect patients interest, and to make the industry more efficient have been being developed at a record pace. A flood of new regulations got introduced in recent years in light of  the Affordable Care Act (ACA) with a very harsh penalties for those that are not compliant. Now, more than ever before it is crucial stay up-to-date with the changes.

In the United States, HIPAA (Health Insurance Portability and Accountability) was enacted in 1996-and Protected Health Information (PHI)  to protect the interests of patients. Following the ACA, and with recent developments in electronic health record (EHR), HIPAA had to bring many new, unforeseen, rules to cope with the situation. HIPAA had to pave the way to digitalize all most every single manner of health care records and processes. This brought on many stringent, yet unexpected implications. Any violation, intentionally or unintentionally, meets with a variety of penalties which get categorized in 4 criteria where “Category-1” is least serious and “Category-4” is most serious. Thus, staying relevant with the ever-evolving regulatory minefield is more important than ever.


Healthcare Compliance Fines

In 2015, many Healthcare companies had to pay huge amounts of fines and penalties for reasons ranging from unintentional mistakes to sheer negligence. If we track back the record, we will find examples like Tuomey Healthcare System in South Carolina paying $237.5 million in fines and penalties, Adventist Health System and its affiliated White Memorial Medical Center in Los Angeles agreed to a settlement of $14.1 million, and Cooper Health System and Cooper University Hospital in New Jersey agreed to a settlement of $12.6 million. Many companies were fined simply because they could not protect patient medical data from hacking.

Now, questions arise, are you up-to-date with new rules and regulations? If the answer is “No”; then, you can expect a hefty amount of fines incurred on your practice for violating a rule that you may not have even heard of. Did you know that all the information regarding patients should be kept in a secure server as an example? If any information can be accessed by any unauthorized personnel this will result in serious fines like “New York-Presbyterian Hospital and Columbia University” had to face in 2014. That hospital paid a 4.8 million dollar in fine to compensate for the deactivation of a network server which resulted in the disclosure of protected health information of more than 6,800 individuals.

How A Consultant Can Help

Now, what does a healthcare consultant do? What does he/she do to save you from costly penalties?  First and foremost, a healthcare consultant identifies the problem in the company he/she is working for. Then that consultant does some preliminary research and examines the  data available to them at that moment to find a solution.  During that process, that consultant considers new rules and regulations. By analyzing that information, a healthcare consultant can find the flaws and correct those.

How can a consultant help avoid costly penalties? Well, a consultant specialized on Healthcare regulations has an extensive experience in this field. Here at iHealthOne we have over thirty such consultants ready to help with a variety of issues surrounding healthcare compliance and regulatory compliance. Leveraging our wide array of clients that have faced similar issues you can get much more done with our team than the hundreds of hours you or your office staff will spend just doing the research. Consultants also have various analytical tools at their disposal to analyze the ensuing new rules and regulations to reach  the best possible conclusion. Our consultants also stay up-to-date with the changes made by HIPAA and other regulatory organizations.

Healthcare Compliance & Your Future.

Healthcare Industries in United States alone have more than $3 Trillion dollars in traction per year, according to Forbes. However, the very same magazine Forbes termed the recent Industry regulatory changes as draconian, and summarized its analysis by describing the industry as an industry which is focused on compliance and regulation rather than patient care. Now, staying penalty free is no longer a matter of economic well-being, rather a way to stay afloat and competitive in an ever-shifting market place. Hiring a Healthcare consultant will benefit a practice in many ways in such a turbulent market climate.

If you need help with compliance issues for you’re medical practice iHealthOne can help. Give us a call today for your first consultation at no cost to you.