Compliance's Paradigm Shift to Quality

While compliance professionals have been focused on their acute healthcare organization’s utilization and medical necessity documentation, compliance enforcement officials have been looking beyond these regulatory minimums.

Today, quality of care is the paramount issue in long-term care compliance.

This means that organizations must manage quality of care not only case-by-case, but also facility-wide, regionally, and company-wide. In short, to avoid compliance problems or to solve them once they occur, long-term care companies must focus on quality improvement.

To do so means first gathering data related to sentinel events and other quality indicators that can be readily analyzed for root causes across cases or incidents. Then organizational processes are required to put measureable and sustainable actions into place. In fact, when compliance enforcement action is required, leaders must verify that problem-solving actions are working to improve quality.

This requires long-term care leaders to think broadly about resident care and quality of life, and then problem-solve from that wider perspective.