Understanding Highlighted & Under-Reported Healthcare Compliance Issues Of 2015/2016

2016 is seeing the Healthcare Industry cope with issues and events such as the following:

• The transformation of institutions from quantity based reimbursement models to quality based and financially incentivized systems that began in 2015 is still underway
• Increasing drug prices due to drug shortages and drug consolidation requiring hospitals to scale their purchases so as to prevent negative effects on their margins
• The rise in internet-connected medical devices is raising cyber-security concerns in terms of hacks and breaches
• Increasing wages for physicians and nurses will add pressure to decreasing margins of healthcare facilities
• The Department of Health and Human Services has become increasingly active about Health Insurance Portability and Accountability Act (HIPAA) violations. Hefty fines are being slapped onto medical teams that violate HIPAA privacy and security laws; if the violations are criminal they will be investigated by the Department of Justice

The above issues show how challenging it is for Healthcare providers in the U.S.

For me, the excitement that comes from being able to reveal an inside view of the industry to my readers encourages me to blog about my understanding of these challenges and obstacles faced by the Healthcare Industry while suggesting possible solutions to resolve the intricate issues. Alongside, it gives me an in depth perspective to read others’ articles and blogs on social media and the internet regarding the challenges introduced to the Industry by the Affordable Care Act (ACA) and HIPAA. It leaves me positively surprised when I come across articles revealing issues that had not been receiving due coverage and reporting.

Past examples of some such articles about issues that had previously not been highlighted extensively are articles published by The Joint Commission in 2015 with regards to the non-compliance of their healthcare facility standards with ‘Hand Hygiene’, ‘Environment of Care’ & ‘Endoscope Decontamination/Disinfection.”

The question is whether issues such as these are new and emerging ones, or have they been prevalent but under-reported or unpublicized? My conclusion after reading through many such articles is that the issues are indeed long standing but were not brought to light.

In 2016, while CMS continues to assess quality across the healthcare industry, there will be a number of organizations that will find it difficult to make the transition from quantity to quality. The industry is yet to see which organizations will able to cope with the new environment and adjust in accordance to the culture as it moves from a reactive, regulatory mindset to a proactive/positive, staff/patient safety model. At the same time, it is necessary for organizations to comply with HIPAA’s requirements with regards to using Internet-based document sharing applications. Following policies and procedures is important in order to reduce potential risks and vulnerabilities; simultaneously reporting and mitigation of incidents has to be ensured by the responsible entities.