By Vincent L. DiCianni

In many professions, carelessness can lead to sanctions or fines. In the medical profession, it can lead to a serious injury or even a loss of life.

Given the nature of healthcare, it's understandable why the industry is so heavily regulated. And it's also understandable why doctors, nurses and other medical professionals find it difficult to keep up with state and federal regulations.

The link between complex regulations like the Health Insurance Portability and Accountability Act (HIPAA) and patient care is not always clear. Given the time needed to learn and apply regulations to a practice, some medical professionals may be tempted to perform a paperwork triage and put aside some of the mind-numbing, time-consuming forms and reports they need to fill out -- or they may inadvertently fill out their paperwork incorrectly.

And paperwork is just part of what the regulations require. Compliance includes a host of different obligations, such as continuing education requirements, workplace safety regulations, employment practices, record keeping and much more.

Falling out of compliance as a consequence of spending more time with patients seems like a reasonable trade off. But the failure to comply with regulations can lead to sanctions, fines or loss of credentialing. In some cases, medical professionals may even lose their license to practice.

We expect perfection from the medical profession, but human beings are not perfect. Even the best of us make mistakes. So is there a better way to resolve regulatory violations, especially for those who inadvertently make a mistake?

Everyone Benefits

There is. Increasingly, licensing boards and other regulatory bodies are using independent monitoring as an option. Monitoring, which is modeled after the Independent Private Sector Inspector General (IPSIG) program developed in New York State, gives healthcare professionals the option of having a professional monitor observe how they do business and help them comply with all regulations in lieu of other disciplinary action, such as the loss or suspension of a license.

Monitors are professionals from many fields, including healthcare, accounting and insurance. The monitor spends time not only observing professionals, but offering advice to help them learn and incorporate the regulations into their practice. Monitors also train medical professionals in best practices, so they can become better, safer, more efficient practitioners and business professionals.

Everyone involved benefits from this model:

• Healthcare Professionals. Monitoring can protect the career and reputation of healthcare professionals. They can avoid fines and penalties, and keep their credentials and license to practice. They can continue practicing while they are being monitored, so they don't have to worry about the impact a disruption in service would have on patient care. In addition, monitoring will improve their understanding of state and federal regulatory requirements to ensure future compliance.

• State Agencies and Licensing Boards. The backlog of medical complaints is growing, while funding for state licensing agencies is being reduced. Monitoring can stretch the budget, reduce backlogs and protect the public, even after the disciplinary case is closed -- all at no cost to the state agency or board, since the licensed professional pays for the monitoring. Because monitors teach medical professionals how to comply with regulations, they are likely to avoid future sanctions.

• The Public. When licensed professionals comply with the laws and regulations that govern them, the public is safer and the quality of service improves. Instead of skepticism, the public's trust and confidence in the integrity of businesses and medical professionals improves.

• Professional Associations. Associations can use monitoring services to provide quick, effective help for their members when they face possible sanctions.

• Attorneys. By helping their clients, monitoring can help attorneys when they defend professionals who face government discipline. When attorneys propose independent monitors as an alternative sanction, they can build a roster of grateful, better-trained clients.

Monitoring is well suited for many violations, but it is inappropriate for the most severe regulatory violations -- especially those where a patient's life is endangered. However, by using monitoring, state agencies and licensing boards can free themselves up from routine cases and spend more time on the most severe regulatory violations.

A Proactive Approach

Of course, healthcare professionals understand that preventive medicine is often most effective. Monitoring may be a welcome alternative to more severe sanctions, but the ideal solution is to make monitoring unnecessary as well.

To succeed in today's highly regulated environment, practitioners and managers of regulated businesses need to identify and address potential problems before they draw the attention of state or federal regulatory, or law enforcement agencies.

In addition to avoiding sanctions, compliance has other benefits. Consider what can happen, for example, when a medical provider fails to keep adequate clinical and billing records. Inadequate records of clinical treatment may be the most common cause of sanctions. In addition to leading to sanctions, failure to keep adequate records can also lead to denial of payment, and possibly even to a government or third-party payor audit or investigation for over-utilization or suspected fraud. Inadequate records can also deprive providers of critical information they may need to defend themselves against lawsuits and patient complaints.

Failure to document the results of all diagnostic procedures adequately can lead to serious questions about the adequacy or appropriateness of the patient's treatment. Failure to document the patient's consent to procedures that involve contact with sensitive areas of the patient's body can also seriously hamper the provider's efforts to defend against a complaint of sexual misconduct or other "boundary violations."

Compliance protects both the patient and the medical professional. To ensure compliance, medical professionals should have a compliance plan in place and regularly update the plan based on the latest regulatory changes.

A preventive, proactive approach improves regulatory compliance and increases patient satisfaction, reducing patient complaints and potential lawsuits, while improving the integrity of the healthcare system. Fewer complaints reduce the likelihood of government intervention. When government intervention takes place, it often results in more stringent regulatory requirements, resulting in higher operating costs.

There are sound business and professional reasons for ongoing regulatory compliance, but when full compliance is not achieved, monitoring can be a welcome alternative.

Vincent L. DiCianni is President and founder of Affiliated Monitors, Inc. (AMI), which has offices in Boston and Westborough, Mass.