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Medication reconciliation is often treated like a compliance task. A form to finish. A box to check. Something that has to be done as soon as possible at the time of admission. But anyone who has worked in patient care knows it isn’t that simple. Medication reconciliation is clinical thinking. It means understanding where a patient started, what changed in acute care, what’s available now, what is redundant or no longer needed, and what still needs to make sense when that pat

One thing my career has taught me is that distance is rarely intentional. I’ve seen it from the bedside. From leadership meetings. From roles responsible for policy, education, and oversight. When compliance feels “separate,” it’s usually because it’s been positioned that way over time — through structure, reporting lines, or simple habit — not because anyone wanted it to be disconnected. But the impact is the same. When compliance sits at a distance, people fill in the gaps

Last week, while attending Health Care Compliance Association (HCCA) 30th Compliance Institute, I had a conversation that stayed with me. A former colleague is in a new role at a medical center. Her compliance department sits structurally apart from much of the organization — with consequences no one likely set out to create. And she’s doing the hard work of closing that distance (brilliantly, by the way). Not by rewriting policies. Not by increasing oversight. But by buildin

Something I keep thinking about after my last post about my son’s class: From the teacher’s perspective, there probably isn’t a problem. The rules are clear. The intent is good. Everyone is being treated “the same.” But from the student’s perspective, the experience tells a different story. That gap doesn’t usually come from bad intentions. It comes from the language we use to describe what’s happening. At the bedside, this shows up all the time. A policy says the process is

Lately, my 10‑year‑old has been frustrated with one of his classes. Not the material — he’s engaged and still putting in effort. It’s the experience of the class itself. From his perspective, the rules feel inconsistent. Situations are interpreted differently depending on who’s involved. Outcomes feel… negotiable — but not in his favor. A small example, but a telling one: At Easter, the girls received beaded bracelets. The boys received rocks with “Jesus loves you” painted on

One of the hidden costs of treating compliance like a visitor is the time spent reacquainting. Because apparently, in healthcare, we have plenty of time for that. Time to remember where the policy lives. Time to re‑interpret language we haven’t seen since last year’s training. Time to figure out how this process was meant to work — not how it actually does. All of this happens, of course, during an already full day. Short staffing. High census. Competing priorities. But sure

My clinical background taught me this early: If a policy can't survive a busy shift, it won't sustain compliance. At the bedside, culture carries systems under pressure - not binders, not reminders, not after-the-fact corrections. That's why compliance works best when it's embedded as culture: familiar, integrated, and grounded in real workflows. This is what I mean by Compliance as Family - where policy quietly supports practice long before anyone calls it "compliance." Wher

No conference. No webinar. Just me, the open road, and watching the back end of a grain truck for 10+ hours. For context: my husband needed a new grain truck, found a used one 8 hours away, and—logistics being what they are—we had to get it home. That grain truck represents a part of farming that’s easy to overlook if you don’t live and breathe it. I know, because before I married a farmer, I overlooked it too. The same thing happens in the compliance world. In fact, many of

Ah—springtime in Iowa. One of my favorite smells is the scent of a freshly cultivated field. (In other words, I love the smell of new dirt in the spring.) To get that fresh‑dirt smell, the tractors must move from field to field using the roads. Moving s-l-o-w-l-y. Often with a line of cars patiently (or not-so-patiently) waiting to pass. On a two‑lane highway. With a double‑yellow line and very short passing zones. If you know, you know. ... That slow, steady pace is exactly

My husband has one of those red buttons in his office — you push it and it proudly announces “that was easy.” A great reminder that some parts of our work are simple. The Anti‑Kickback Statute (AKS) is not one of them. Every time I teach or review compliance programs, AKS comes up. Not because people are trying to be sneaky, but because it’s one of those regulations that looks clean on paper and gets messy fast in real life. Take one SNF–hospital situation I saw years a

🧠 The Habit of Systems Most people think systems slow them down. You and I know the truth: a well‑built system gives time back. I’ve always been a creature of habit. And yes, I’m one of those people who will write a task down just to cross it off. (Go ahead and roll your eyes — I’ll be over here happily checking boxes.) Before EMRs, my “brain sheet” was my lifeline. Neat boxes. Clean lines. Everything in its place. · Patient name, age, diagnosis in the top left ·

Because “that’s how we’ve always done it” isn’t a justification. It’s a warning sign. That phrase grates for a reason. Not because change is easy—it rarely is—but because unexamined routines in healthcare can quietly turn into risks. I get teased by my husband and son for rearranging systems just to see if they work better, but in care settings, regular evaluation isn’t tinkering. It’s responsibility. For years, psychotropic, antipsychotic, and anticonvulsant medications have

My WHY. I had a plan. God had a different plan. Freshman year of college, a car accident changed everything. No visible injuries — just two seatbelt bruises. But my brain bounced inside my skull. Traumatic Brain Injury. Six months in the ICU, inpatient rehab, and outpatient recovery. That experience changed my major, my career, and my calling. March is Brain Injury Awareness Month. Today, I'm sitting in my hotel room at the Brain Injury Association of Iowa's 34th Annual Conf

I probably won’t get the “Favorite Child” award. I am ok with that because it means that I’ve pushed my parents into thinking about uncomfortable topics. My parents had their will and end-of-life documents completed awhile ago. But, things changed when my brother, the executor began having som his own health issues. Which prompted me to have the conversation that, likely, took me out of the “Favorite Child” spot. Life is constantly changing, much like the residents in a nursi

"Because I said so" isn't good enough. Not for my newly-turned-10-year-old. Not for your nursing facility team either. My son recently questioned why he needed to wash up for dinner after helping on the farm. I could have pulled out the classic Gen X parenting card I inherited from my Boomer parents. Instead, I gave him context. Clean skin. No bacteria. Simple WHY. Problem solved. Here's where compliance comes in: The OIG's Nursing Facility Compliance Program Guidance identif

The OIG’s Industry Segment-Specific Compliance Program Guidance (ISPG) for Nursing Facilities is a 59-page document that describes: ~ Risk areas for nursing facilities ~ Recommendations for mitigating those risks ~ Important info nursing facilities should consider in their compliance and quality programs While the document states use of the word “should” is used to present voluntary, non-binding guidance, implementing the “should” items will be of great benefit to the faci

A recent article from Skilled Nursing News discussed the OIG’s Nursing Facility Industry Segment-Specific Compliance Program Guidance, specifically addressing the Medical Director requirements and QAPI projects. Quick history lesson: The OIG began publishing Compliance guidance in 1998, impacting hospitals and nursing facilities. This continued for the next 10 years, expanding into areas such as pharmaceuticals. In 2023, the OIG began a modernization initiative to update the

§ The Two-Midnight rule is a Medicare policy for determining inpatient admissions on Medicare Part A. Basically, it states that inpatient admissions are payable if the admitting physician expects the patient to require a hospital stay that crosses two midnights. So, what happens to a patient who has a Medicare Advantage (MA) plan, has an inpatient admission, recovers more quickly than expected, and is discharged prior to the completion of two midnights? While these scenarios

Many people set a New Year’s goal of losing weight and exercising more. BUT… What if we shifted our thinking to setting a goal to age well? That’s how I started 2025. I had watched my grandparents grow old and am now watching my parents age – I see which habits impacted their health and wanted to do things differently. (I’m also closer to 50 years-old than 30 and want to keep up with my 9 y/o son.) Almost a full year later, I feel better. I’ve increased tone and strength. I c