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Get on the same page with regulators

January 1, 2008
by Nicholas A. Roes, PhD
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The relationship between treatment providers and regulatory agencies is too important to be allowed to be reduced to an “us versus them” mentality. For every time program staff has been frustrated by a bureaucratic obstacle to high-quality care, a regulator has been frustrated by program practices that leave clients at risk.

Providers and regulators are partners, not adversaries. Our missions are highly compatible, and this article is designed to help programs relate to regulators in a way that gets the most for their clients. If you don't already, learn to appreciate the partnership and shared mission that programs have with auditors and regulators. Public servants are attracted to their positions for one of the same reasons people are drawn to the addiction field: a genuine desire to make a real difference in people's lives. Those whom our programs serve and those whom the regulations are designed to protect are the same people.

Work to understand the reasons behind the regulations. The goal is never to make treatment more difficult, to irritate treatment staff, or to put programs out of business. Those charged with overseeing operations and protecting our clients would be negligent if they required only a program's promise to do a good job. Even though your program may never have mistreated a client or been negligent, it is important for you and for others to have this confirmed by an objective third party.

A productive audit

View every audit as an opportunity to improve services. In 20 years as a program director, I've never had an audit or inspection I didn't learn from, and I confess I was not always happy about the lesson at the time it was received. Regardless of whether you are pleased with every interaction, there is always something you can take from the experience to help you do better for your clients and do better on the next audit.

Things go much better when you know what to expect. Demonstrate your understanding of the audit process and goals by having everything your auditor will need to do the job. Many states will help you prepare for audits by providing you with a copy of the review instrument that an auditor will use.

Provide a quiet, comfortable place for the auditor to work. Be sure it is private, that a phone is available, and that sufficient staff is available to be called upon to answer questions. Have all the required documents in one place and readily available. This can be accomplished by making copies of all documents that will be requested and keeping them in a special file just for audit purposes. Keep what you need for each inspection (licensing, fiscal, health, safety, etc.) in a separate binder and update it regularly. This will demonstrate respect for the auditor's time and mission.

Be conscious of the first impression you make on an auditor. Nobody can help starting to form opinions on the basis of how organized you appear, how polite you are, or how profusely you are sweating.

If you've had any bad experiences, put past differences or difficulties aside so they don't taint the current relationship. You wouldn't appreciate it if the auditor related to you as if your program were one of the minority that abused patients and billed for phantom clients. Assume the best of intentions and you'll almost always be right.

Be honest
. Even the slightest stretching of the truth 1% of the time will give an auditor a valid reason to doubt you the other 99% of the time. Many auditors appreciate your bringing problems you are working on to their attention, and will offer advice on solving them. This expression of partnership will lead auditors to adopt a forward-looking mentality (collaboration on improving things for clients in the future) rather than a backward-looking approach (“gotcha”).

Don't “yes” your auditor to death. Auditors usually can tell when a program understands and is trying to comply with regulations, as well as notice that a program does not value regulations very highly. Sharing only your name, rank, and serial number sets the tone for an interrogation. A genuine conversation leads to the most productive relationship for both parties.

When you disagree

If you have a genuine area of disagreement with your auditor, there is always a mechanism to appeal. Once you have communicated your point of view successfully, that mechanism is a better avenue to pursue than badgering the auditor. Don't over-promise in your audit response—include only what you are sure you will be able to accomplish in the agreed-upon time.

Follow through on the response to which you have agreed. There are few things that cause as much concern as a return visit where previously cited problems have not been addressed. Nurture a mutually supportive relationship between audits as well.

Finally, don't judge an audit or an auditor by how well you did. An overly lenient inspector leaves a program at greater risk at the next review. A really tough reviewer could help you pass future inspections with flying colors.

Regulations make horrible masters, but they are excellent servants. For both auditors and program staff, complying with the spirit of the regulations is at least as important as meeting all the regulatory standards. Make a connection with the spirit of the regulations, understand the goals, and devote your energy to achieving them.

Nicholas a. roes, phdNicholas A. Roes, PhD, has written hundreds of articles and several books, including

Solutions for the `Treatment-Resistant’ Addicted Client (Haworth Press, 2002; reviewed in the January 2003 issue of