Emily A. Boyd
Senior Editor
Loyola University Chicago School of Law, JD 2019

Cheryl Miller is the Director of Risk, Compliance and Legal – and Chief Compliance Officer for Presbyterian Homes, a Life Plan Community (formerly branded as a Continuing Care Retirement Community (CCRC)) in Skokie, Illinois. Ms. Miller worked as a corporate paralegal for several years before and during law school, first at a large law firm and then at Brookdale Senior Living. She moved into healthcare regulatory work, and from there learned about the Health Care Compliance Institute and went to the annual meeting.  “The preciseness of Stark and Anti-Kickback and the other multitude of regulations enthralled me. I was on-site at a client (Presbyterian Homes) two days per week providing risk management services.  I asked about their compliance program and gave (what I thought was) constructive criticism.  A year or so later, Presbyterian Homes hired me away from the firm.” Ms. Miller was recently invited by Professor Larry Singer to speak to his Health Care Business and Finance class about the Long-Term Care industry. Her discussion enlightened many of the students and inspired enrollment in Loyola’s Long-Term Care course. The following is an interview that highlights her insight and experiences about her work in an often-overlooked area of healthcare.

Q: What is the structure of the compliance program at Presbyterian Homes? How it is unique, and how does your role fit into the program and organization as a whole?

When I was hired, the compliance program started out as a meeting that was required (and that no one wanted to go to). I started bringing relevant things to the table that should be discussed (leasing space, revising clinical agreements, etc.) and still received reports from many departments and did most of the talking about compliance topics that affected Presbyterian Homes. After a discussion with the new Chief Operating Officer, he and I agreed it should be more dynamic, structured, and the reporting structure revised.  And I should do less talking.  We still have quarterly Corporate Compliance Meetings, but now each [of the three campuses] has monthly compliance meetings [that I attend]. The Campus Compliance Officer reports quarterly to me at the Corporate Compliance Meeting – and I take these reports and present them to the Board. . . two to three weeks after the Corporate Compliance Meeting.

Each campus has a monthly dashboard of measures (number of admissions, number of OBRA screenings, number of background checks, etc.).  If there is a variance or we don’t meet the self-set goal, we talk about why (e.g., if there are 30 new admissions, the reason why we have 27 back ground checks is because we are still waiting for three, etc.).  If something comes up, we ensure there is a procedure that is followed or we draft one (e.g., we actually received a “hit” on a resident’s background check, and were required to discharge the resident for a particular reason.).  We also have a monthly work plan, which identifies which month we verify [things like] RN licensure, when we review/revise the facility assessment, and when HIPAA (and other) training is due.

Moving from a quarterly Corporate Compliance meeting where I mostly heard my own voice, to monthly campus meetings and a Corporate Compliance meeting where the Campus Compliance Officers report took a while, but it is/was worth it.  Doing so has made it evident that what people do at each campus every day is compliance, makes an impact on the organization, shows other people what they actually do, and hold everyone accountable for their actions and results.

Q: What does a typical workday look like for you?

I review risk incidents and (if I have any) send comments and questions to the VP of Clinical Services, Health Care Administrators and Directors of Nursing.  For everything else, I prioritize my to-do list and attend to that – whatever is urgent or will have the most impact among the campuses is more of a priority.  Legal questions, policy review, investigations, nudge [and encourage various parties] on projects, etc., it varies from day to day.  In October and November, it is insurance renewal time for us, and it takes time to shepherd the information together. We also have an employee engagement program, and I read all of the submissions to ensure that [HIPAA and patient privacy are maintained; if there is an indication that re-training is needed], the entry is edited, and the employee/author receives an in-service.

Q: What aspects of long-term care make your work different from that of other professionals in similar roles at other organizations?

Presbyterian Homes is a Life Plan Community, and there are regulations and laws for the different levels of care, [as well as for] the skilled nursing facility part.  And, some regulations cross over and affect other parts.  I must be able to look at the forest as a whole, yet be able to turn my attention and focus on a specific tree if need be.My title is Director of Risk, Compliance and Legal – and Chief Compliance Officer.  Compliance impacts or touches a lot of the organization, and it can be seen as overlapping with the operational aspect.

Q: What are the most frequent compliance/ethics issues that face the long-term care industry? Why are they different from healthcare generally?

Health care in general is regulated, but long-term care is more regulated because of the vulnerable population it serves,and the seemingly relative ease of certain people abusing the system. The most frequent compliance issues I read about is billing – how clinical professionals submit false claims and receive tons of money.

Q: Where do you see the future of compliance in long-term care heading? Why?

[I see a variety of] new laws and new ways to comply developing.  There will always be regulations, and they usually are playing catch up with technology. Take telemedicine:  Medicare is moving swiftly with these regulations, which will be a boon to rural areas.  Physicians and other clinical professionals will become more efficient and will be able to “see” more patients per day.  This, however, can potentially give rise to [fraud and abuse and the submission of false claims].

Q: Is there something about compliance you wish you had known before you began your career in the field?

Compliance means, in general, to obey the laws and regulations that govern that particular industry.  In some ways, I like the rigidity of it.  But, it can be too rigid if only the laws and regulations are looked at.  How compliance affects a business’ operations (and its revenue) and vice –versa is worthwhile to think about.  With time comes experience and knowledge, and it is easy to say: “If I had to do it again, I would ________.”   Taking a class or getting perspective on the bigger picture – how compliance applies to the particular business – would have been time well-spent.  I try to do it now.

Q: What skills do you think compliance professionals need to develop to succeed and prepare for that future?

Learn how you work, and learn how you can work well with others.  The person who can say, “There is a new law out there that we must comply with, and here’s how we can do it…” and get feedback and input on how it will affect everyone else, is a good team player.

Listen more than you talk.  You may hear an underlying reason for something in the conversation that will affect whatever answer you give or whatever you are responding to. And, don’t be pedantic.