Compensation The Business of Healthcare

Wringing Profit From Physician Group Compliance: Operational Compliance


As you may know, the Patient Protection and Affordable Care Act, Obamacare, imposes a requirement – a mandatory requirement — that physician groups adopt compliance programs.

These programs are not simply plans that you document, toss into a notebook and keep on a shelf – they must be living breathing programs revisited on an ongoing basis.

Now most medical groups will view their compliance efforts as completely divorced from their operational issues. So in essence they’ll erect a wall in between compliance and operations and proceed on each of those tracks independently.

But the better performing groups – those that I call the strategic groups — will use a different approach, an approach that I call Operational ComplianceTM, in which compliance efforts are intertwined with the group’s operations in order to address both the need to maintain an ongoing compliance program — that’s the risk management side — and to wring efficiency and profitability out of the group’s operations.

Looking at this another way, traditional compliance work is a cost  — it’s money spent, well spent, managing risk.

But in Operational ComplianceTM, a significant portion of the funds devoted is an investment in identifying potential areas of profit:  For example, this could be improving the speed of coding, billing and collection, it could be mining information for performance improvement, or it could be improving team-level performance – these are merely a few examples.

The fact is that you have to have a compliance program. So the question is do you want to have one that’s a cost incurred for the laudable reason of managing risk, or do you want go the rest of the way and turn a portion of what’s spent into an investment providing ROI – return on investment —  to your group  — an upside, in addition to managing risk.

That’s Operational ComplianceTM.

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