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The Evolving Role of the Healthcare Compliance Officer

compliance training

No matter what job, if you’ve worked in healthcare for three years or 30, you know the job has changed over time. That’s certainly been the case for Sheryl Vacca, Senior Vice President and Chief Risk Officer at Providence St. Joseph Health, a $24-billion company with 130,000 caregivers in seven states, who can look back over three decades in healthcare, during which time she moved from providing bedside care as an RN to a job that covers audit, risk management, and information security teams. And in her case, the evolution continues as the duties and role of compliance officials continues to shift alongside the healthcare landscape’s twists and turns.

“What attracted me to this was that it encompasses compliance, audit information, security, and risk,” Vacca says. “This is the way that we need to be functioning going forward—all these risk partners working together. Regulations have been there since day one. They can be very constricting. The economy is being impacted by healthcare spending; it’s 18 percent of the GDP, a real target for those wanting to reduce cost. Politically, we’re seeing that in areas such as the ACA and how those changes are occurring as well as the effect of trying to restructure Medicaid and Medicare. It’s quite interesting as you go through what is happening politically and look at the impact that it might have in the compliance field. We have to especially be cognizant of what is happening nationally because that is actually what’s driving the changes in compliance.”

Mergers and Acquisitions Mean New Players

As such a huge part of the economy, healthcare continually draws the attention of outside investors. That brings a new depth of complications to compliance, because those partners are pursuing revenues and may not be aware of the minutiae that makes up so much of healthcare regulation. Again, compliance to the rescue.

“Mergers and acquisitions that are occurring in healthcare with partners that we would never expect to be partners with,” Vacca explains. “Amazon is an example where they haven’t really fleshed out their healthcare focus, but they have made it known that healthcare is an area where they plan to be a partner. From a healthcare perspective, it’s very difficult for us to really demonstrate our return on investment. We really have to look at different ways to get alternative streams of revenue and we have to look at ourselves differently from being a bricks-and-mortar hospital organization to being something that is more valued by our consumers and by our patients.”

What does that look like? For starters, healthcare providers are digging into areas such as telehealth, telepsych, services that can connect providers and consumers outside the physical hospital. Freestanding EDs and walk-in clinics also dot the new landscape.

“We are very oriented to delivery systems that are outside bricks and mortar, going back to bringing the services to the consumer where the consumer is,” she says. “Of course, one of our key priorities is to try to keep individuals from seeking care in the ER or in the hospital. A better outcome would be to be in the community where they are, so we’re more easily accessible and affordable. They also are seeking preventative care and looking at their overall health of their well-being.”

Now more than ever, compliance officers need to be at the table when leadership convenes to look at, and work through, these changing delivery systems and other major healthcare shifts. Vacca advises compliance professionals to capitalize on inclusion when they have it, not just by rejecting ideas out of hand due to potential regulatory risks, but to explain why and how the rules work, and how savings can still be realized.

“As individuals in the organization understand the value that a compliance officer’s input can bring, and they understand how much time and effort could be saved if the compliance officer was identified as part of the necessary team when the discussions were occurring, there will be a change in inclusion,” she says. “I view myself more as the guardrail more than the naysayer, and I think that’s really appreciated in the organization.”

About Sheryl Vacca:

Healthcare compliance expert Sheryl Vacca is Senior Vice President and Chief Risk Officer at Providence St. Joseph Health, a $24-billion company with 130,000 caregivers in seven states. Her responsibilities include oversight for compliance, audit, risk management, and information security. Previously, she served as the system-wide senior vice president for chief compliance and audit officer at the University of California. Vacca has received awards from the Society of Corporate Compliance and Ethics (SCCE) and the Health Care Compliance Association (HCCA).

This blog post is taken from a HealthStream Second Opinions Podcast that was recorded recently. To hear Vacca’s full discussion, click here.