healthcare regulations

At least 25% of organizations are spending fewer than 1,000 hours on compliance per year. Considering that there are 8,760 hours in one year, compliance could be more streamlined to decrease the time facilities spend on this. That could entail better resource allocation and simplified workflows that produce better results.

Multiple factors contribute to regulatory issues across the healthcare industry, often including issues that range from patient privacy protections to big data upkeep to junk insurance. To keep up with the way healthcare laws and regulations shift and issues arise, professionals would do well to monitor their compliance efforts and progress in one place.

1. HIPAA: Why You Should Prioritize Protecting Patient Privacy

One of the most crucial regulations for healthcare facilities is the Health Insurance Portability and Accountability Act (HIPAA). This law sets the standard for protecting sensitive patient data and facilitates patient trust.

In 2023 alone, there were 553 breaches across the healthcare industry that resulted in more than $4 million in fines. Many of these breaches were avoidable with the right systems in place.

Why It’s Essential

HIPAA is essential for multiple reasons, from reducing the risk of HIPAA-related violations and enhancing healthcare interoperability to increasing patient data security and making medical records more accessible without risking patient privacy. From healthcare clearinghouses to health plans and providers, HIPAA provides legal guidelines to enforce more physical security controls across healthcare businesses.

This often includes not just physical security controls but safeguards for administrative and technical workflows as well. At least 96% of acute care hospitals alone have adopted a certified electronic health records system, and four in every five office-based physicians are doing the same. HIPAA compliance will always be a top priority for most facilities.

Penalties for Noncompliance

Failing to comply with HIPAA can result in severe penalties. HIPAA violations include civil monetary penalties ranging from $137 to $68,928 per violation. While there is a maximum limit for annual penalties, the reputational damage often experienced by violation and financial strain can set a facility back in multiple ways.

Beyond financial repercussions, noncompliance can severely erode patient trust and satisfaction, and this can directly affect the assistance a facility receives.

2. Emergency Medical Treatment and Labor Act (EMTALA)

The Emergency Medical Treatment and Labor Act (EMTALA) mandates that anyone coming to an emergency department must be stabilized and treated. Treatment must be delivered regardless of insurance status or ability to pay. This specific regulation is critical in ensuring that emergency medical care is highly accessible.

While this applies primarily to hospitals with emergency departments, it should not be overlooked.

Why It’s Essential

Although EMTALA has formed the safety standard for the American healthcare system, a variety of violations still occur. These violations often range from inappropriate transfers of patients with emergency medical conditions (EMCs) to failure to stabilize patients with an EMC and failure to screen for an EMC at all.

Penalties for Noncompliance

Any organization that fails to comply with EMTALA regulations will face civil penalties. These penalties often range from $64,618 to $129,233 for every violation.

In addition, physicians can be sued for the damages they caused, and facilities that violate EMTALA can be excluded from Medicare eligibility.

3. PSQIA: You Won’t Get Far Without Quality Improvement

The Patient Safety and Quality Improvement Act (PSQIA) is a federal law that focuses on improving patient safety and the quality of healthcare. This act is enforced through a reporting system that helps track medical errors and events that fall within patient safety concerns. While this type of reporting is voluntary, participants are highly encouraged to participate within its guidelines.

Why It’s Essential

Participating in PSQIA is essential for facilities that want to be more transparent and enhance continuous improvement. By reporting and analyzing patient safety events, you can better identify trends and develop preventative strategies based on your findings.

Penalties for Noncompliance

While PSQIA itself does not impose direct penalties for noncompliance, failing to participate in quality improvement initiatives and programs can have indirect consequences. These can include higher rates of adverse patient safety events, which can lead to lawsuits, increased insurance premiums, and complete loss of reputation. Also, facilities that do not engage in safety and quality reporting could miss out on funding opportunities tied to quality performance measures.

Managing Healthcare Regulations with Software

As healthcare regulations often shift, adhering to published changes directly affects the success and credibility of any practice. From protecting patient privacy with HIPAA to ensuring PSQIA participation, these healthcare regulations and guidelines are the backbone of ethical and effective healthcare delivery.

To better meet healthcare laws and regulations, while also making compliance monitoring and reporting simpler, work with Compliancy Group’s curated solutions that fit a variety of facilities.

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