It is not easy being a medical group or health system right now. Organizations are faced with...
Compliance Risk and Reward in Healthcare: The Power of Purpose-Built Technology Platforms
Compliance is already hard, and using outdated technology is making it harder - and riskier.
Healthcare is one of the most highly regulated industries in the country, posing a perennial challenge to hospitals, health systems, and medical groups trying to keep up. In the realm of healthcare compliance technology, can we really depend on spreadsheets to help our healthcare systems keep track of all their data? That seems to be the most common strategy among administrators. Certainly, spreadsheets remain the most common technology tool used for administering highly regulated functions like compensation and staff sourcing: 97% of compensation managers, for example, use Microsoft Excel.
However, the sheer complexity of the regulations governing healthcare has long since outpaced the capabilities of such tools. Instead, modern, purpose-built technology is key to ensuring accuracy and enforcing internal and external rules. That’s because spreadsheets fall far short of what is needed in today’s regulatory environment. Instead of saving healthcare organizations from compliance risk, spreadsheets may be worsening them.
Unacceptable Risk of Error
Fully 88% of spreadsheets contain errors, largely thanks to how much manual labor it takes to wrangle them. If nothing else, the manual transfer of data from original sources to spreadsheets increases the risk of inaccuracies and makes administering competitive, legally compliant compensation plans more challenging.
Purpose-built technology closes that gap in healthcare data security and accuracy. “A modern provider compensation management technology solution like that offered by Hallmark Health Care Solutions is going to automate data aggregation,” says Aarika Cofer, Vice President, Heisenberg II, at Hallmark Health Care Solutions. “In other words, all that data we had been entering ourselves started interfacing directly into the system, cutting down manual data entry by at least 75%.”
It’s not just raw data accuracy, either; it’s the timeliness of the data too. Outdated data in healthcare IT systems can cause as many problems as incorrect data, highlighting the critical need for robust healthcare data protection measures. By integrating directly with relevant data sources, modern platforms ensure that compensation-related information is up-to-date, accurate, and reflective of current regulatory standards.
Limited Ways to Enforce Policy
Internal and external rules cannot be programmatically “built into” a spreadsheet the same way they can within purpose-built technology solutions. “Spreadsheets struggle to meet—much less enforce—most organizations’ processing governance standards,” says Neeraj Isaac, co-founder and CTO of Hallmark Health Care Solutions. “A modern data processing environment can and should incorporate an audit mechanism that gives auditors the comfort of knowing all standards have been met. Excel simply can’t do that.”
Plus, comprehensive logging and reporting provide transparency and facilitate audits, supporting organizations in demonstrating compliance efforts.
Delays and Redundancy
Time-consuming and inefficient, spreadsheets ultimately just increase the “surface area” of compliance vulnerability, creating more opportunities for potential violations. Automation in healthcare compliance can significantly reduce these vulnerabilities. For instance, compliance-related data is often duplicated between multiple healthcare IT systems, increasing risks and requiring massive manual labor to manage. “The routine, redundant, and remedial tasks prevalent in healthcare are overwhelming,” Darrell Bodnar, CIO of North Country HealthCare (Flagstaff, Ariz.) tells Becker’s Hospital Review. “Whether we are trying to get paid or meet a compliance directive, the volume of repetitive tasks that must be completed every day is incredible. Automation of repetitive tasks is a pain point that we can immediately have an impact on.”
So, if spreadsheets fall short of what’s needed in today’s regulatory environment, how can other, more modern technologies meet the compliance needs of modern HCOs?
The Compliance Landscape in Healthcare Provider Compensation
Provider compensation is a minefield of compliance risks due to federal regulations like the Stark Law that, even individually, can be challenging to manage. With medical compensation management technology, these challenges can be more effectively addressed. For example, CMS has enacted nearly three dozen Stark Law exemptions, “each of which has its own set of complex rules and requirements with which providers must comply if they wish to be protected.” And that’s just a single applicable law.
Managing that complexity requires tools that can accommodate the depth and breadth of relevant regulations and all their nuances. Spreadsheets, however, make it difficult from the start. Consider simply importing data from all groups. Even if the initial data transfer was flawless, post-import manual adjustments often never get updated in Excel at all. For example, RVUs not tracked in the EHR may never be manually tracked and keyed into Excel.
Interoperability—integrating the compensation management platform directly with other systems, like the EMR and payroll—solves this problem. If the system encounters potential exceptions in the data, it can outright disallow them and/or automatically flag potential violations before they occur, allowing for proactive risk management.
Compensation-related compliance risks are further complicated by the accelerating transition into value-based care models. A purpose-built compensation management tool, like Heisenberg II PC, can offer real-time updates, audit trails, or role-based access control—all critical features for maintaining compliance in a changing landscape where inadvertent errors can lead to significant penalties.
The Compliance Landscape in Workforce Management
Workforce management offers no less of a labyrinth of labor laws, accreditation requirements (like tracking expired credentials), and clinical licensure standards. Systems and processes for tracking these items are, again, either manual and/or housed in a system limited to one department or function.
Worse, the data is rarely available to the frontline manager in real-time at the moment of scheduling, so decisions that fall afoul of regulatory requirements can easily get made in the heat of the moment. Managing qualifications, shifts, overtime, and labor costs thus becomes an exercise in complexity that Excel spreadsheets are ill-equipped to handle. That also imposes a compliance burden unless the platform used, like Einstein II, can handle credentialing to make sure labor is both fully vetted and a good fit for staffing needs.
Here too, the purpose-built platform can leverage a combination of interoperability, automation, and intelligent decision-making. By integrating staffing, onboarding, scheduling, invoicing/billing, and compliance management together in a single source of truth system, the technology can reduce the manual burden, minimizing both the risk of human error and FTE hours among administrators.
In short, the risks of persisting with outdated tools are too significant to ￼ignore, making the adoption of digital healthcare solutions not just a preference, but a necessity. Purpose-built technology platforms like Heisenberg II and Einstein II offer healthcare organizations the tools to manage provider compensation and the workforce effectively while rigorously meeting compliance and risk management mandates. Such platforms can meet and tame the complexity of compliance in the healthcare space. By investing in these advanced systems, the organization can be confident that every function and transaction is executed accurately with as little legal risk as possible.