Assessment of Misinterpretation of Regulation by Compliance Professionals: A Multimethod Study.

Abstract

Background: The volume and complexity of administrative regulations, standards, and associated tasks contribute to administrative burden in health care. Misinterpretation and misapplication of regulations impede efficiency and contribute to professional dissatisfaction.

Objectives: The authors aimed to 1) understand the compliance professional role, training, and background; 2) uncover their perspectives toward documentation and administrative burden; and 3) identify common regulatory misconceptions by compliance professionals.

Methods: In June 2023, the authors surveyed a sample of professionals serving in compliance roles listed within the directory of a national network of federally qualified health centers. Data were collected through REDCap. Follow-up interviews were completed with 4 participants between September and November of 2023. Descriptive statistics were calculated for all quantitative variables; interview transcripts were analyzed using rapid qualitative analysis. Methodological triangulation was employed to identify themes across survey and interview responses.

Results: About one-third (5/16, 31%) of compliance professionals had formal training. The majority (15/16, 94%) agreed or strongly agreed that "If a clinician's action is not documented it is not 'done.'" Compliance professionals' perceptions of regulatory adherence in clinical scenarios showed high variability, with some participants noting noncompliance in situations where there were no regulatory infractions. Participants perceived administrative burden and waste in health care but diverged in their views of whether they have a role in protecting clinicians from administrative burden.

Conclusions: This study reveals inaccuracies in compliance professionals' interpretations of regulations and standards and suggests a gap between written regulations and interpretation at the organizational level. This overinterpretation may create unnecessary work for physicians and their teams.