Compliance Program Effectiveness: What To Measure and How To Measure It?

Compliance Program effectiveness can be difficult to measure, but critical to an organization's compliance program.  Now, the Health Care Compliance Association (HCCA) and the Department of Health and Human Services, Office of Inspector General (OIG) teamed up to develop metrics that can help health care providers measure the effectiveness of compliance programs.  The metrics are published in a new guidebook entitled,  "Measuring Compliance Program Effectiveness: A Resource Guide" ("Resource Guide").  The metrics outlined in the Resource Guide are based on the Compliance Program Elements from HCCA's CHC Candidate Handbook: Detailed Context Outline, which include:

1. Standards, Polices, and Procedures; 
2. Compliance Program Administration;
3. Screening and Evaluation of Employees, Physicians, Vendors, and other Agents; 
4. Communication, Education, and Training on Compliance Issues; 
5. Monitoring, Auditing, and Internal Reporting Systems; 
6. Discipline for Non-Compliance; and
7. Investigations and Remedial Measures. 

Under each of these Elements, the participants offered suggestions regarding "what to measure" and "how to measure" it.  Unlike many existing pronouncements on Compliance Effectiveness, this compendium focuses not only on program structure and processes, but also on outcomes.  It offers a lengthy list of various metrics that are aimed at measuring effective compliance, along with corresponding suggestions on how to measure each one.  While it provides a multitude of options and details, this Resource Guide was not meant to be a stringent checklist or a one size fits all approach.  Providers are advised to utilize only those measures that are relevant and appropriate, based on their risk areas, size, resources, and industry sector. 

There are several common themes throughout the Resource Guide that apply to nearly all health care providers in measuring effective compliance.  First, many of the tools suggested for measuring can be used at any organization to gauge certain compliance measures.  Some of the more common tools and techniques for measuring include audits, document reviews, surveys, interviews, observations and focus groups.  Although the extent to which these tools may be helpful varies amongst providers, utilization of some combination or variation of these tools will undoubtedly provide meaningful feedback to any provider.  This feedback will assist providers in identifying, prioritizing and remedying those compliance areas that need improvement. 

Second, there are also categories of metrics that impact multiple Elements.  For example, culture is a continuous theme throughout the Resource Guide.  Many of the metrics seek to measure the "culture of compliance," a phrase used frequently by New York's Office of the Medicaid Inspector General, in order to gauge the understanding of, and adherence with, compliance obligations among staff.  These cultural measures are also aimed at determining effectiveness in program implementation and administration, education, reporting, and investigations.  To improve in these compliance areas, however, providers must actually use the appropriate metrics to measure their "culture of compliance" within the organization. 

Awareness of compliance is also measured consistently throughout the various Elements and their underlying metrics.  Whether it is "Awareness of the Investigation Process" (e.g., strategic relationship with risk partners) or awareness related to the "Code of Conduct," awareness is a key ingredient to an effective compliance program.  The metrics related to awareness are especially important when measuring the level of education/training of employees on compliance.  In view of that, it is important that employees are not only aware of compliance, but understand the compliance program and their responsibilities.  If providers wish to know their staff's levels of awareness, then providers must be willing to measure some of these key metrics. 

Providers would be well-served to take the time to review the Resource Guide and determine which metrics and measurement tools are applicable to them.  Regardless of size, resources, or specialty, by identifying and measuring those metrics, providers can improve their overall compliance program effectiveness. 

The Resource Guide can be found at: https://oig.hhs.gov/compliance/101/files/HCCA-OIG-Resource-Guide.pdf