Overview

MetricStream solution provides a flexible framework to streamline the creation and management of a healthcare organization’s policies. The solution enables organizations to adopt an electronic and automated approach to the development, maintenance, and communication of policies and procedures across the enterprise.

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Policies and procedures form the bedrock of a health organization’s success. Sometimes, they can make all the difference to an organization’s survival. Physicians, stakeholders and staff depend on policies and procedures to establish standards on how various processes must be conducted – from processing payments, to protecting patient information, to meeting healthcare compliance regulations, to admitting patients, to conducting surgical procedures.
 

Auditors, regulators and attorneys also rely on an organization’s policies and procedures to determine if services delivered were in line with company norms. If not, the organization runs the risk of encountering noncompliance penalties or, worse, lawsuits stemming from the occurrence of fatal medical errors.

Could these losses have been prevented with an effective policy and procedure management system?

  • In 2008, a health care provider was exposed for refusing to enroll pregnant women and unhealthy patients despite being required by law to accept all eligible beneficiaries. The provider paid $225 million in settlements.
  • In 2009, one of the nation’s largest health insurers was accused of overcharging millions of Americans for healthcare. The insurer was required to pay $50 million in settlements.
  • In 2010, a surgical centre agreed to pay $51,300 for allegedly entering into several types of financial agreements with referring physicians without the requisite written agreements in place, as required by the Stark Law.

Policies and procedures are becoming increasingly more important as healthcare organizations grow larger, more diverse and more complex. To ensure consistency in operations, reduce medical errors and ensure patient safety, organizations need to ensure that they have a well-defined and well-implemented set of policies and procedures in place.

Challenges of Policy and Procedure Management

Excessive documentation: Healthcare organizations are constantly confronted with piles upon piles of paperwork relating to patient records, insurance information, healthcare compliance requirements and more. To top it off, they are faced with policy and procedure documents which can stretch into thousands of pages, covering all kinds of processes, from recruitment, to billing, to administration of medication, to regulatory practices. Given the enormity of information, it can be extremely difficult to manage, store and quickly retrieve documents whenever required.

Manual document management: Many healthcare organizations continue to store information regarding policies and procedures in dozens of thick, unwieldy binders. Sifting through this documentation is extremely time-consuming and laborious. A doctor who needs information quickly for an emergency procedure, could end up wasting valuable time looking through bulky binders.

Security risks: While electronic document management may be more efficient and cost-effective, it also introduces new risks such as hacking and information theft. Protecting confidential information from these risks is a constant challenge, as cybercrime grows more sophisticated every day.

Information silos: Because healthcare organizations typically function in specialized silos, their policies and procedures are also managed in independent silos. As a result, it becomes difficult to locate a compliance policy, much less to track employee compliance with these polices. It can also result in the unknowing duplication of policies and procedures across the enterprise, which in turn, increases spend unnecessarily.

Increasing compliance regulations: Healthcare organizations are confronted with a growing plethora of compliance regulations. From HIPAA, to CMS, to OIG, to RAC audits, each regulation requires separate policies and procedures. HIPAA policies have to be maintained for six years, in addition to other information such as privacy practices, notices and complaints dispositions. The result is hundreds of pages of documentation.

A robust policy and procedure management system helps you…

  • Ensure that top quality patient care is provided
  • Comply with norms such as HIPAA, CMS, RAC audits and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
  • Develop, implement, standardize and modify policies
  • Coordinate and track the distribution of policies
  • Eliminate out-dated, contradictory information that could result in legal action
  • Train staff on policies and procedures
  • Streamline policy management workflows

MetricStream Solution for Policy and Procedure Management

MetricStream provides a flexible framework to streamline the creation and management of a healthcare organization’s policies. The solution enables organizations to adopt an electronic and automated approach to the development, maintenance, and communication of policies and procedures across the enterprise.

The web-based system contains a central repository to store and organize policy and procedure documents. Integrated collaboration and workflow tools can be used to access, create, modify, review, and approve these policy and procedure documents globally in a controlled manner. Built-in tools support policy implementation, acceptance, exception tracking, mapping of policies to compliance requirements and event based notifications. In addition, a powerful analytics and reporting capability tracks each policy from origin to obsolescence, giving managers complete visibility into the system.

Storing and organizing policies
The MetricStream solution provides a central repository for storing and organizing all types of healthcare policies based on various formats, templates and classification criteria. A revision history is maintained, and a review period or obsolescence rules can be set for all policies. The solution allows multiple users across departments and functions to access and work on a policy development simultaneously. The solution also supports versioning and check-in / check-out functionality for effective change control

Intuitive Search
MetricStream Solution’s Universal Search Functionality provides powerful online indexing and database search capabilities for authorized users to retrieve policy information for various requirements. It offers quick and easy access to relevant information spanning an organization's current and historical policies and other documents. Advanced search conditions can be created using sub-expressions and connectors.

Creating and reviewing policies
The solution allows users to easily create a new healthcare policy or make changes to an existing one. Tasks for creating, reviewing and approving policies and procedures are assigned based on roles and responsibilities along with due dates for completion. Using collaboration tools, various users can review policy at the same time to add their comments and instructions, leveraging the redlining functionality. This information canthen be routed for analysis as per the workflow and process map.

Upon completion of the review and the approval process, the policy is published for all relevant stakeholders with appropriate email notifications sent to a predefined distribution list or user groups.

Mapping policies to regulations
The solution provides tight integration between policies and procedures, and the compliance, risk and control framework. This includes dynamic links and references betweenthe two as well as change controls and audit trails. If compliance activities such as a remediation or control redesign require changes in the policy documentation, users can initiate document changes seamlessly from within the compliance framework. The system also allows users to identify and record any impact of a policy change on the compliance program.

Distributing and accepting policies
MetricStream Solution contains a built-in automatic notification and alert functionality with configurable workflows. This facilitates healthcare policy distribution and acceptance. The system also provides the capability to configure and execute surveys, conditional questionnaires,certifications and self-assessments to manage policy distribution and acceptance for designated executives. It supports electronic signoffs at departmental and functional levels that roll-up for executive certifications.

Tracking policy exceptions
Policy exceptions can be tracked in MetricStream solution through a comprehensive issue management mechanism. The solution enables healthcare organizations to establish and follow consistent procedures for exception capture, reporting, task management and status reporting. The solution supports the identification and evaluation of exceptions as well as investigation and tracking, leading to an elaborate remediation or corrective action process. A powerful analytics and exception capability offers managers complete real-time visibility into policy related issues. It also provides critical information for reducing the risk of noncompliance with healthcare policies.

Training and awareness
MetricStream provides powerful capabilities for enabling training and awareness of a healthcare organization’s policies and procedures. It brings together a comprehensive content repository and a framework for simplified training delivery and tracking. The solution ensures that the training requirements are fully met and recorded from a compliance policy standpoint. It also provides employees easy access to a variety of training programs that map to various guidance documents, policies, procedures, regulations and standards.

Reports and dashboards
The MetricStream solution provides complete visibility into the policy and procedure system with easy status tracking. Each policy is traceable from any desktop in the organization. This makes policy and procedure management a predictable and efficient process.

Graphical executive dashboards and flexible reports with drill-down capability provide statistics and data by a variety of parameters such as policy types, status, audit history, in-process documents, approval cycle times, usage summaries and average review times.

Value Proposition

  • Ensure easy archival and retrieval of healthcare policies with MetricStream’s centralized policy management repository
  • Map policies to regulatory compliance requirements
  • Automate and streamline policy management workflows
  • Receive updates on policy changes with MetricStream’s automated alerts, assignments, notifications and escalations
  • Track policy updates and comments through time-stamped audit trails
  • Record and resolve exceptions, and track issues
  • Ensure data security and role-based access control
  • Execute surveys to affirm acceptance and adherence to policies
  • Enjoy complete visibility into the system with easy policy status tracking
  • View policy management status in real-time through powerful executive dashboards with drill-down capabilities
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