Question

Give as much as information of following.

COMPLIANCE

The Office of the Inspector General focuses on the provision of guidelines for compliance pertaining to physician group practices. One may think that the seven core elements of compliance is fully understood, however each of these elements take a great deal of time and energy to complete for any group practice.

The Fairway medical group is located in the state of Newberry. They have five facilities at this time. Each of the facilities consists of eight physicians, sixteen employees and twelve contracts with acute hospitals. One of the centers, located in Patton, has not provided four out of the seven core elements of compliance.

The first compliance issue pertains to the lack of written guidelines and policies set forth to demonstrate the organization's commitment to regulatory commitment.

The second issue of non- compliance was the lack of effective training and education. This training and education is needed for the employees, physicians, and anyone working in a relationship with the group practice.

The third compliance issue dealt with the lack of the group practice auditing systems which was not presented in the compliance policies of the group practice. The fourth compliance issue focuses on the lack of documentation and communication within the structured hierarchical structure.

The analysis of this case, must present why the one facility out of five did not meet the compliance criteria. There are many issues that could be presented such as lack of leadership, lack of management, or lack of a hierarchical structure.

For the case study analysis is to be broken down into the following steps.

Identify the most important facts surrounding the case.

Identify the key issue or issues.

Specify alternative courses of action.

Evaluate each course of action.

Recommend the best course of action

Answer 1

The focus of the Office of the Inspector General is on the guidelines for compliance pertaining to physician group practices, which includes seven core elements of compliance. Any group practice needs a great deal of time and energy to practice these. The Fairway medical group in Newberry state has five facilities; each one with eight physicians, sixteen employees, and twelve acute hospital contracts. Of these facilities, one in Patton has provided only three core compliance elements and has four non-compliance issues, i.e., the key issues. These non-compliance issues are:

1. Lack of written guidelines and policies to demonstrate the facility's commitment.

2. Lack of effective training and education for anyone working for or is in a relationship with the group practice.

3. Lack of the group practice auditing systems.

4. Lack of documentation and communication within the hierarchy.

Alternative courses of action and their evaluation:

1. Provide the required written guidelines and policies and implement it by making it mandatory. By making this mandatory, compliance is assured.

2. Provide effective training and education for employees and other related people. A test should be conducted to assess their understanding, and passing this test should be made part of the contract.

3. Implement a group practice auditing system. Required number of audits should be done and these should be made mandatory by the Office of the Inspector General to ensure this is followed.

4. Mandatory documentation and communication within the hierarchy should be implemented by strict scrutiny. This would surely make the facility compliant in this aspect.

Office of the Inspector General should elevate all the noncompliance issues and give warnings to the Fairway medical group as well as the non-compliant facility and take further disciplinary actions if still found to be non-compliant. Better compliance can be ensured by making all these mandatory and under strict scrutiny till 100% compliance is obtained. This is the best course of action for any compliance issue pertaining to physician group practices.