Risk Management in an Endocrinology Practice

PRESENTED BY Nancy R. Smit, MBA, RPT, RRT

PRESIDENT, SHR Associates, Inc.

SHR Associates, Inc.147 Old Solomons Island Road, Suite 504

Annapolis, Maryland 21401Phone 410-897-9888 Fax 410-897-9889

www.shrassociatesinc.com

The Endocrine Society - CMES Ancillary SymposiumENDO 2009 – Washington, D. C.

Friday, June 12, 2009

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In today’s challenging healthcare In today’s challenging healthcare environment, Risk Management environment, Risk Management programs play an increasingly important programs play an increasingly important role in fulfilling the commitment of role in fulfilling the commitment of healthcare professionals to provide the healthcare professionals to provide the best quality of care, as well as the best quality of care, as well as the continuous assessment and improvement continuous assessment and improvement of the quality of care and services of the quality of care and services rendered to patients.rendered to patients.

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The primary goal of a successful The primary goal of a successful

Risk Management program is to Risk Management program is to

improve the quality of patient care improve the quality of patient care

and reduce the probability of an and reduce the probability of an

adverse outcome or a medical adverse outcome or a medical

malpractice claim.malpractice claim.

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Risk Management programs are Risk Management programs are designed to reduce the risk to designed to reduce the risk to patients and the resulting liability to patients and the resulting liability to the provider and the sponsoring the provider and the sponsoring facility/organization.facility/organization.

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A comprehensive Risk Management A comprehensive Risk Management program should include the following program should include the following componentscomponents::

1.1. the continuous defining of clinical the continuous defining of clinical standardsstandards

2.2. outcome studiesoutcome studies

3.3. providing dataproviding data

4.4. analyzing systemsanalyzing systems

5.5. monitoring clinical practicemonitoring clinical practice

6.6. affirmatively correcting problems affirmatively correcting problems that have potential or actual riskthat have potential or actual risk

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Managing medical and non-medical Managing medical and non-medical

risk in your endocrinology practice is a risk in your endocrinology practice is a

three (3) step process:three (3) step process:

1.1. identifying the areas of risk.identifying the areas of risk.

2.2. avoiding or managing the risk of avoiding or managing the risk of

loss.loss.

3.3. reducing the impact of losses reducing the impact of losses

when they occur.when they occur.

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• Medical injury, poor result, or adverse Medical injury, poor result, or adverse outcomesoutcomes

• Provider errors/negligenceProvider errors/negligence• Unrealistic patient Unrealistic patient

expectations/outcomesexpectations/outcomes• Lack of Informed Consent, honest Lack of Informed Consent, honest

communicationcommunication• Weak physician/patient trustWeak physician/patient trust• Patient depersonalizationPatient depersonalization• Unprofessional behavior of provider/staffUnprofessional behavior of provider/staff• Unresolved misunderstandingsUnresolved misunderstandings

FACTORS THAT LEAD TO MEDICAL RISK:FACTORS THAT LEAD TO MEDICAL RISK:

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A professional and compassionate A professional and compassionate patient-provider relationship is the patient-provider relationship is the cornerstone of any good risk cornerstone of any good risk management program.management program.

Patients rarely bring actions against Patients rarely bring actions against physicians they trust or perceive are physicians they trust or perceive are trying their best to serve them.trying their best to serve them.

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• Greet and acknowledge the patient by nameGreet and acknowledge the patient by name• Introduce yourselfIntroduce yourself• Provide support and reassuranceProvide support and reassurance• Facilitate dialogueFacilitate dialogue

– What are they presenting for (i.e., identify What are they presenting for (i.e., identify their request or problem)?their request or problem)?

– What do they think is wrong, or what do What do they think is wrong, or what do they think is needed?they think is needed?

– What do they expect from treatment?What do they expect from treatment?• Respond and educateRespond and educate• Express a warm good-byeExpress a warm good-bye

Setting the Stage for a PositiveSetting the Stage for a PositivePatient/Provider RelationshipPatient/Provider Relationship

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Taking proper steps to terminate the Taking proper steps to terminate the

patient/provider relationship is very patient/provider relationship is very

important. Ending the relationship in important. Ending the relationship in

an adversarial manner can create an adversarial manner can create

serious risk management concerns, serious risk management concerns,

and may be illegal.and may be illegal.

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– Patient must be notified of the decision to Patient must be notified of the decision to

terminate (minimum 30-day advance terminate (minimum 30-day advance

notice).notice).– The current treatment plan must be The current treatment plan must be

completed.completed.– The termination process, including the The termination process, including the

reason for termination, must be reason for termination, must be

documented in the medical record.documented in the medical record.– Alternative providers must be identified Alternative providers must be identified

and made available to the patient.and made available to the patient.

Guidelines For Proper Termination Guidelines For Proper Termination of the Patient/Provider Relationshipof the Patient/Provider Relationship

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Although national statistics indicate Although national statistics indicate that over half of the physicians in that over half of the physicians in practice will be sued twice during their practice will be sued twice during their careers, there are some very basic careers, there are some very basic steps that you can take to reduce your steps that you can take to reduce your risk.risk.

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Clearly and courteously communicate Clearly and courteously communicate with your patients. Listen carefully with your patients. Listen carefully to their concerns, answer all of their to their concerns, answer all of their questions, and fully explain any questions, and fully explain any procedures are recommending.procedures are recommending.

STEP 1:STEP 1:

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Train your staff to maintain Train your staff to maintain organized and complete patient organized and complete patient records and to treat your patients records and to treat your patients with respect.with respect.

STEP 2:STEP 2:

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Fully document all aspects of the Fully document all aspects of the patient visit, taking adequate patient visit, taking adequate time to explain your rationale for time to explain your rationale for treatment and to record patient treatment and to record patient compliance or non-compliance.compliance or non-compliance.

STEP 3:STEP 3:

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Establish good systems and Establish good systems and

procedures for tracking and procedures for tracking and

following-up with all patients following-up with all patients

regarding lab results, referrals, regarding lab results, referrals,

and additional appointments.and additional appointments.

STEP 4:STEP 4:

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Mistakes Mistakes

Happen!Happen!

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Current research supports the fact Current research supports the fact

that when physicians apologize for that when physicians apologize for

medical errors, they significantly medical errors, they significantly

reduce their chances of being sued reduce their chances of being sued

for malpractice.for malpractice.

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One of the most effective ways to One of the most effective ways to

identify and address clinical risk in identify and address clinical risk in

your practice is to form a Quality your practice is to form a Quality

Improvement Team (QIT) with Improvement Team (QIT) with

multidisciplinary representation.multidisciplinary representation.

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The QIT should meet on a regular The QIT should meet on a regular

basis to develop formal incident basis to develop formal incident

response plans and to address response plans and to address

service issues, potential claims, service issues, potential claims,

and actual claims.and actual claims.

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Both patient and staff complaints Both patient and staff complaints

should be formally documented and should be formally documented and

investigated promptly by the QIT investigated promptly by the QIT

for their merit. Recurring service for their merit. Recurring service

issues generally signal that aspects issues generally signal that aspects

of the practice’s quality of the practice’s quality

management process needs management process needs

improvement.improvement.

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Actual claims materialize as a Actual claims materialize as a

written notice that a patient written notice that a patient

intends to sue. During the period intends to sue. During the period

between a claim notification and between a claim notification and

formal filing of a suit, a QIT can formal filing of a suit, a QIT can

play an important role in helping to play an important role in helping to

mitigate the claim.mitigate the claim.

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All formal claim notices from All formal claim notices from

patients or patient attorneys should patients or patient attorneys should

be immediately submitted to the be immediately submitted to the

practice’s malpractice carrier’s practice’s malpractice carrier’s

attorney.attorney.

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If your carrier’s malpractice If your carrier’s malpractice

attorney writes a letter to the QIT attorney writes a letter to the QIT

requesting their assistance in the requesting their assistance in the

investigation, a state of attorney-investigation, a state of attorney-

client privilege exists and all client privilege exists and all

discussions are considered discussions are considered

confidential from a legal confidential from a legal

perspective.perspective.

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The QIT should help to create a The QIT should help to create a

continuous quality improvement continuous quality improvement

process that, over time, helps to process that, over time, helps to

significantly reduce major liability significantly reduce major liability

risks for the physicians and their risks for the physicians and their

medical practices.medical practices.

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Non-Medical Areas of Risk in Non-Medical Areas of Risk in Medical PracticeMedical Practice

Non-medical/administrative areas of risk within medical offices include:

ADAHiring and firingSexual harassmentOSHAHIPAABilling Compliance

Medical Identity Theft

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Quality assurance and patient Quality assurance and patient

satisfaction will determine where the satisfaction will determine where the

future healthcare dollars are going to future healthcare dollars are going to

be spent. Physicians need to make be spent. Physicians need to make

their Risk Management programs an their Risk Management programs an

integral part of their operations in integral part of their operations in

order to maintain the quality of their order to maintain the quality of their

services and increase market share services and increase market share

in this challenging healthcare in this challenging healthcare

environment.environment.