Five Action Items for Health Care Executives and Board Members, Part Three

Putting aside hotly contested issues such as the proper scope of federal authority and the cost of expanded coverage, the new law has pragmatic implications for health care providers in five broad areas that will affect provider activity in a number of different ways.  Today is the final post in the series.

Five Action Items for Health Care Executives and Board Members, Part Three

5. Address the Regulatory Challenges of Increased Transparency, Accountability, and Overall Payment Reform
Of course, most change initiatives combine so-called carrots with sticks. PPACA does focus on activities and values related to enhanced quality, value and cost management in health care. However, the law also emphasizes increased information transparency and disclosure, provider responsibility and accountability, which, combined with enhanced regulatory compliance tools, will surely provide DHHS and other regulatory enforcement bodies with a number of hefty enforcement tools.

Most objective observers would agree that the majority of today’s providers strive to “do right” and abide by relevant fraud and abuse, antitrust and other laws . . . as such provisions are understood today. Yet the combination of enhanced transparency and oversight, coupled with new compliance criteria, will likely mean that some behavior representing today’s “typical” business practices may soon be redefined as illegal is tomorrow’s evolving regulatory environment. This circumstance, which is amplified since the new laws don’t generally grandfather existing arrangements for compliance purposes, makes it critical that providers pay close attention and devote needed resources on assessment and prevention, rather than relying only upon remediation when legal compliance problems are detected. Since actions risking exclusion from Medicare can effectively constitute a professional death penalty for individuals and institutions alike, prevention and self-management through strong compliance initiatives will certainly constitute an important investment in the future.

The precise strategic, tactical and other measures to be used by health care providers responding to the new law will obviously require tailored consideration within different communities. Nonetheless, the magnitude of changes brought about by the new law, and the expedited timeline within which those changes will occur, prompt a call for action. As a result, health care executives, physician leaders, and board members of hospitals and health systems within a given region will want to apply their existing capabilities and resources to promote movement into the new health care paradigm.

In this week-long series, we posted five articles that we hope helped you understand the primary areas targeted by new health care legislation so you can focus your efforts accordingly and position your organizations for the transformative changes that lie ahead.

Do you have any questions?  Comments?  Let us know!

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