Factors which are affecting service delivery can have a positive impact on how Health Care is expedited. Regulatory Compliance Health care is a highly regulated industry and continues to tighten and continually develop criteria according to which providers are required to abide by in order to carry out business. It has been estimated that HIPAA (Health Insurance Portability and Accountability Act) cost 33 cents for every health care dollar spent between 1996 and 2002.
The health care industry covers a wide array of participants all of which all are inevitably subjected to a multitude of regulations and who are all required to exercise compliance to avoid fines and penalties. This poses as one of the leading factors and challenges that the practice of healthcare faces today. In light of the fact that regulation increases the difficulty in which a healthcare facility operates potentially causing huge losses in revenue it also brings with it positive aspects and outcome from which an organisation can capitalise on.
Concepts and Strategies Gartner, 2003 identified security for privacy and data collection compliance as one of the top 10 issues within healthcare at the time and an area of which absolute importance was misunderstood and the cost of significant spending by healthcare organisations. Breeches in confidentiality could lead to major law suits, and loss of medical records posing further spiral of unnecessary financial expenses.
Data recording is an important aspect in healthcare as it tracks the patients all important background and history and speeds up the time taken to assess new patients by ensuring continuity of consistent and quality treatment. It is for this very reason that health care organisations depend on electronic databases and informatics to track and record patient information. Not only does it track diagnosis, treatments number of visits, patient history but also age, gender, ethnicity, location, insurance details and the like.
This helps to manage information internally, share information between relevant parties, gain easy access for clients, issuing medications more swiftly, ultimately creating a paperless environment accelerating the flow of operations, ensuring accuracy. It also allows the organisation to store a wealth of information which can be used as a guide to identify services which are doing well, which could later be geared for expansion and further investment. It also provides information on emographics and patient census which could serve as a guideline and assist when plotting marketing strategies. ‘’Gartner, 2003 suggests that providers must focus on automations systems to support their business strategy in order to meet the following goals:’’ i. Improve operational efficiency ii. Increase access to information internally and externally iii. Support customer/consumer-focussed initiatives Health Professional Quality Assurance is an aspect of a health care organisation which also needs regulation.
Local regulatory bodies do random inspections to ensure health professional are practicing ethically, safely and using the highest standards of practice. Professionals are required to maintain continual professional development and keep updated with the latest trends and developments in their respective fields. By way of the organisation investing in these professionals, not only do they ensure compliance with the local regulatory governing body but also do they ensure quality assurance which ultimately translates to the public and finally into better revenue.
On the one aspect factors affecting service delivery could be seen as a negative entity, as it has the potential to drive costs up and result in an organisation to run at a loss. But with careful planning, strategy and organisation it is evident that such factors could in actual fact accelerate a business model. It pays to invest in risk management as it is clear that an organisation that is risk resilient minimises profit loss and achieves adherence to federal regulation which furthermore then has the right to utilize it as a foundation for consumer credibility. ’Health Insurance Portability and Accountability Act of 1996’’ All healthcare organizations are affected in some way by HIPAA. The entities that are affected include all healthcare providers (even one-physician offices), health plans, employers, public health authorities, hospitals, life insurers, clearinghouses, billing agencies, information systems vendors, service organizations and universities. The rules of HIPAA are published by the Department of Health and Human Services (HHS) and enforced by the Centres for Medicare and Medicaid
Services (CMS) and the Office of Civil Rights (OCR). While the provisions stated in the Act, they can be overridden by laws created by individual states, meaning that healthcare organizations need to be conscious of both federal and state government laws in this area. HIPAA calls for severe civil and criminal penalties for noncompliance, including: Fines up to $25,000 for multiple violations of the same standard in a calendar year
Fines up to $250,000 and/or imprisonment up to 10 years for known misuse of individually identifiable health information The two main rules of HIPAA are: Privacy Rule: Organizations must identify the uses and disclosures of protected health information (PHI) and put into effect appropriate safeguards to protect against an unauthorized use or disclosure of that PHI. When material breaches or violations of privacy are identified, the organizations must take reasonable steps to solve those problems in order to limit exposure of PHI.
Compliance with HIPAA’s PHI guidelines was required of all covered entities, regardless of size, by April 14, 2004. Security Rule: Defines the administrative, physical and technical safeguards to protect the confidentiality, integrity and availability of electronic protected health information. Covered entities are required to implement basic safeguards to protect electronic protected health information from unauthorized access, alteration, deletion and transmission. The final rule states that all covered entities, with the exception of small health plans, must be compliant by April 21, 2005. Small health plans must be compliant by April 21, 2006.
Net IQ,‘’Addressing Regulatory Compliance in the Healthcare Industry ‘’, (January 2006) John Dugan, 2010 ‘’Challenges faced by providers-Minimising risk and reducing cost of regulatory compliance’’ (www. pwc. com)