How Rapid Growth Can Result In Regulatory (and Legal) Non-Compliance - And How to Prevent It

New start-ups' rapid growth can lead to process breakdowns and non-compliance in multiple areas over time. Here's how to prevent or stop it.

When hospice owners and operators open a new provider or denovo location, there’s usually a very small team managing the new start. The team members balance shared or dual roles until the census picks up and the location gains profitability.

Sometimes a small team logistically feels easier to keep on the same page and supervise their work at a detailed level. Communication is quick and simple, get everyone in one room or make 3 phone calls. Done.

When rapid growth in the census of workload occurs, and/or rapid growth in new team members happens, the processes and structure have to change.

In that change, day-to-day practices can fall through the cracks, new team members with different education levels and habits are brought in and one very experienced person with extensive knowledge may move from one area to another. Leaving someone behind to pick up the pieces, figure out the process and try to get caught up with everything that happened in the meantime. Or sometimes in my experience, no one.

It may seem like a mild inconvenience, but it’s actually a major risk for serious non-compliance to creep in. On the surface staff is new to hospice, new to the processes, struggling to figure out routines, stretched thin, and focused on making sure patients are seen and not suffering.

Here’s what can happen next if not corrected quickly:

Processes erode as long as rapid growth continues
Staff don’t feel supported and feel like growth is taking priority over the care
They start taking shortcuts, using workarounds they have no idea are not compliant
Staff bring it to leadership's attention, but there is no one involved in the day-to-day operations on site who isn’t so intimately involved they can’t recognize and correct the problems
Often someone who feels like they are personally at risk, like the medical director, case manager, or administrator brings attention to an outside entity like the OIG to escalate the unaddressed concerns.
The hospice is investigated and it’s found that compliance and eligibility issues weren’t addressed during the period of rapid growth and is fined, or closed.
Owners and stakeholders held accountable can be sued, fined, arrested, and face loss of their licensure. Staff involved suffer too.

How to prevent or stop this from occurring or correct it in progress:

Consider that there aren’t enough resources for direct care and field-level staff to feel confident they are meeting and exceeding regulations
Accept the possibility that the growth diluted the culture in some areas and clinician engagement and willingness to communicate concerns through proper channels is reduced.

New staff may not feel comfortable using the compliance resources available for being labeled as "troublemakers" (been there, done that, got the t-shirt, and it really sucks).

Consider the following courses of action:

Conduct regular interviews and surveys to gain real perspective from field staff if they're still somewhat engaged
Bolster onboarding and orientation around compliance, resources available internally, and processes that ensure compliance.
Create personal connections to internal support for leaders and new hires
Increase tools for reference and reinforcement of education nd processes. Try alternate education approaches. Staff may have education fatigue from the new process and frequent rapid changes.

A final caveat, I have personally seen this happen with leaders at the branch and also the regional level. Rapid growth and laser focus on operations with very limited clinical and educational resources and support created non-compliant and even fraudulent practices that leaders found themselves involved in, unintentionally, over time, like a frog boiled slowly in a pot of water they were then left holding the bag for the violations, accused as the perpetrator and feeling like the victim.

Was this helpful for you? Have you seen this happen or experienced it yourself?

Categories: Leadership, Operational Excellence