Achieving Quality Care through Compliance

Healthcare providers continue to be confronted with multiple challenges: higher acuity levels, shrinking reimbursement, a national nurse staffing shortage, more stringent and complex regulations, and increased litigation. As a result, the struggle to maintain compliance with regulatory requirements often appears to be an uphill battle. 

This is especially frustrating to owners, administrators, clinical staff, and researchers who aim to go beyond compliance to provide innovative care and services. In some instances, patients in institutional settings, such as hospitals, nursing homes or assisted living facilities, may be at risk based upon the failure of providers to address the basic care needs adequately.

David Hoffman & Associates is a healthcare consulting firm providing a proactive approach to clinical compliance, viewing clinical and financial operations as well as clinical research programs through a legal lens to:

• Create a culture of compliance.
• Conduct an evaluation to assess the degree of compliance.
• Collaborate with the provider to develop a plan for compliance.
• Identify organizational strengths and develop an action plan that helps organizations realize their fullest potential.

Creating a culture of compliance is accomplished through a customized plan that includes varying degrees of the following:

The development of systems to provide quality care to vulnerable populations requires meaningful quality improvement efforts. These efforts systemically monitor organizational and clinical processes of care. We are consistently revising these processes based on clinical and regulatory outcomes. Care concerns must be incorporated into the principles governing corporate compliance. David Hoffman & Associates brings legal and clinical expertise in addressing these difficult issues.

The Cost of Non-Compliance

We'd rather not look. Perhaps if we avert our eyes long enough, the unpleasantness will simply disappear. After all, if we don't look, we relieve ourselves of the obligation that comes with seeing.

For more than three decades, it has been my job and my responsibility to see what others have either refused to acknowledge or, due to inadequate checks and balances, simply have not noticed. I have walked the halls of hospitals, nursing homes, and assisted living facilities throughout the country and collected pieces of a mosaic, each of which helps construct a vivid pattern of a caring staff, difficult challenges in ensuring appropriate care delivery, vulnerable residents and patients, and a payment system that is not reflective of the needs of these populations.

I realize that health care providers face a variety of challenges: staff shortages, complex regulations, increased litigation. And I do believe that most want to provide the best care possible. Yet, all too often, there is a systemic failure in meeting the needs of patients and residents. At David Hoffman and Associates, we can help you meet your challenges and provide quality care. This is our job and we have a track record of success.

Reform must begin with the recognition of the casualties of non-compliance. They are sons and daughters, grandmothers and grandfathers, brothers and sisters. They are our most vulnerable citizens, and providing quality care that actually goes beyond compliance is not only a moral obligation but it is good business.

In the last 30+ years, including more than a dozen as a federal prosecutor specializing in health care fraud and abuse, I have seen the cost of non-compliance, to patients, residents and providers. I have consulted with hospitals, nursing homes and assisted living facilities which were under external pressure to "clean up their act" and threatened with criminal and civil sanctions. I prosecuted dozens of cases, both civil and criminal, in which hospitals and long-term care facilities were forced to pay significant amounts of money in settlements and fines. It can all be avoided.

We want to help health care providers create a culture where care and compliance are intertwined. We can evaluate your systems and design a plan that capitalizes on your organization's strengths and improves your weaknesses. And we will continually monitor your systems and revise them based on clinical outcomes and regulatory concerns.

I urge all health care providers-owners, administrators, clinical staff members-to take an honest look at the challenges before you. The inventory might be alarming and frustrating. But the failure to see will come with an even greater cost.