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Can’t live without it, better manage with it: regulation in health care

Regulation of the health care industry has its place, considering the stakes in the industry are life and limb. However, professionals in the field also know that sometimes oversight of the industry can be a roadblock.

“Health care is one of the most regulated industries, and the rules are often old, archaic and conflicting with one another,” Children’s Hospital Colorado CEO Jena Hausmann told Tamara Rosin of Becker’s Hospital Review. “They create waste, inefficiencies and costs, and they really inhibit our ability as an industry to innovate and transform the care delivery system the way we need to best serve our patients.”

One example of Hausmann’s complaint is the bias against telehealth within Medicaid and Medicare. While physicians can expand their capacity by as much at 19 percent through technology allowing virtual instead of physical visits, many physicians are unable to fully invest in the technology because government programs and insurers will not pay as much for televisits as they will for in-patient visits.

Christine Sinsky, MD, FCACP, of the American Medical Association also has some issues with archaic regulations, telling Stephen Swenson, MD, MMM, FACR, of Intermountain Healthcare at an NEJM Catalyst event last year that regulations need to be updated to take into account “new models of teamwork.”


Not only can regulation suffocate innovation, but it can also be incredibly hard to keep up with because it is constantly being revised. So much so that students not yet working in health care are advised to start keeping an eye on the regulatory process while still in school so as to be prepared once they enter the workforce.

Regulations are ever-changing, and adding to the complexity is that so many different organizations, both governmental and private, enforce those regulations. Health care organizations must remain compliant with rules and regulations from an assortment of regulators, including accreditation boards, state medical boards, Clinical Laboratory Improvement Amendments, Occupational Safety and Health Administration, Health Insurance Portability and Accountability Act, the Center for Disease Control and Prevention, the Office for Civil Rights, The Joint Commission, the Food and Drug Administration, and the Patent and Trademark Office, among others.


In his book Health Care Regulation in America: Complexity, Confrontation and Compromise Robert I. Field, JD, MPH, PhD, argues that the complexity of oversight in the industry is in line with the American system of check and balances and has resulted in innumerable advances in the last century. Those health care workers in the field, though, might argue those advances would be even more numerous with more flexibility.

Others may wish to keep regulation but expect more from it.

Audrey Andrews, chief compliance officer for Tenet Healthcare Corp, wrote in an article for Modern Healthcare that she believes “the compliance programs of the future will be expected to help deliver better patient care, bend the cost curve, improve employee engagement, protect the organization’s reputation and, most important, solve problems that cut across the silos of health care.”


Regardless of what happens in the changing health care regulatory environment, professionals in the industry must work within the current frame of oversight, spending a vast amount of time making sure their organizations are compliant with the many regulatory bodies. In light of that truth, health care professionals must look for other places in their day where they can become more efficient.

PolicyStat minimizes time spent preparing for audits as well as the stress produced from that preparation. When health care organizations manage their policies through our software, they can spend their time on other elements of their missions, such as patient engagement and satisfaction.


How does your organization manage regulation? We hope you take the time to examine your own processes and improve what you can. As always, we love to hear from you and welcome your input on our posts. Get in touch with us on Facebook and let us know what you think!

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