This course is available on-demand here: https://allceus.com/member/cart/index/search?q=Risk+and+Disaster+Management or as part of our Recovery Residence Administrator Training Program https://allceus.com/member/cart/index/product/id/619/c/
Objectives
What is Risk
~ The combination of the probability of an event and it’s consequences
Benefits of Risk Management
~ Provides a framework for consistent, quality services
~ Improves decision making, planning and prioritization
~ Contributes to efficient use/allocation of resources
~ Protects and enhances assets including reputation
Types of Financial Repercussions
~ Suits against the agency for:
~ Medical bills
~ Lost wages / earning capacity
~ Pain and suffering
~ Emotional distress and loss of ability to enjoy life
~ Property damage
~ Wrongful death
~ Punitive damages if there was negligence
~ Loss of funding
~ Loss of license
~ Loss of reputation (client base)
Classifying Risk
~ Consequences
~ High: Financial impact is likely to exceed Z; Significant impact on the organizations ability to operate.
~ Medium: Financial impact is between Y and Z and will have a moderate impact on operational abilities (layoffs?)
~ Low: Financial impact is less than Y and will have a low impact on ability to operate.
Probability
~ High: 25% chance it will happen in a 12-month period
~ Medium: 25% change it will happen in a 10 year period
~ Low: Less than 2% chance of occurrence or Not likely to occur in a 10 year period
Multiple Types of Risk
~ Strategic and Financial (Keep $$ coming in)
~ Organizational Objectives
~ Cash Flow
~ Service Market
~ Legal and Regulatory Issues
~ Employee Risk (Maintain Efficient Workforce/Reduce Turnover)
~ Workers Compensation
~ Termination
~ Burnout
~ Injury or Victimization
Types of Risk cont…
~ Technology Risk (Regulatory and Legal Compliance)
~ HIPAA/HITECH compliance
~ Meaningful use
~ Data Breach
~ Disaster (Data failure)
~ Patient Safety Risk Management (Regulatory and Safety Compliance)
~ Physical Environment
~ Interpersonal
~ Client/Client
~ Client/Staff
~ Destabilization
Common Suits Against Therapists for Patient Safety Issues
~ Boundary violations
~ Inappropriate or excessive self-disclosure
~ Dual Relationships
~ Using techniques without proper training (or licensure)
~ Deliberately using incorrect diagnosis to get insurance coverage or other funding
~ Inadequate documentation (paybacks)
~ Wrongful death
~ Breach of confidentiality
Common Suits Against Agencies
~ Sexual Harassment
~ Environment of Care (Safety)
~ Improper billing practices
~ Billing for services not provided
~ Unbundling
~ Waiving copays and deductibles
~ https://www.hollandhart.com/waiving-copays-and-deductibles
~ http://cbsbilling.net/ioi-copay.html
~ http://www.hcpro.com/REV-46459-2477/Beware-of-waiving-copays-and-deductibles.html
~ https://www.webpt.com/blog/post/legal-compliance-one-more-reason-to-collect-patient-deductibles-and-copays
~ Therapist malpractice
~ Wrongful termination / Civil rights
General Questions
~ Based on information provided from other resources, managers should conduct analyses to determine potential risks. The analysis should identify:
~ What could possibly happen?
~ How likely is something to happen (measuring risk)?
~ How severe will the outcome be if something did happen?
~ How can the likelihood something will happen be mitigated on the forefront?
~ What can be done to reduce the impact (and to what degree)?
~ What is the potential for exposure or what cannot be proactively avoided?
Example: Slip and fall inside; slip and fall on stairs leading into the office
Prevention
Risk Analysis
~ A systematic approach to evaluating risks to business operations and patient safety
~ Start with one area, i.e. Environment of Care.
~ Identify all possible risks based on personal knowledge and historical research
~ Classify risks based on probability and consequences
~ Develop a plan to address/remediate risk
~ Ensure a budget for “risk funding”
~ Ensure all individuals are aware of their responsibility for risk reporting and management
~ Regularly audit for risk management compliance
~ When an event occurs, review whether risk management policy mediated risk.
Policies and Risks They Address
~ Agency has a written code of ethics
~ Staff/Client environment of care
~ Agency carries general liability insurance
~ Personal injury
~ Damage to property (Client’s or Act of God)
~ Comply with State and Federal guidelines and the guidelines of payors
~ Financial Risk (fines/closing/criminal charges/loss of funding)
~ Reputation
Policies and Risks
~ Clearly identify staff qualifications and their duties
~ Environment of care (reduce frustration, grievances and abuse reports)
~ Support guidelines for termination
~ Ensure environment is free of alcohol and drugs via policy, possibly including contraband search and random drug screens
~ Drug free workplace/Worker’s compensation
~ General liability
~ Client relapse/overdose
~ Needle sticks
Policies and Risks
~ Collect and report accurate process and outcome data (intakes, length of stay, successful completion, unsuccessful terminations, AMAs)
~ Reputation/Strategic Positioning Agency and the Field
~ Funding
~ Accounting system documents all monies owed, billing, payments
~ Policy to address nonpayment of fees
~ Cash flow
~ Ethical complaints/reputation
~ Prevent client abandonment
Policies and Risks
~ Client rights and emergency procedures (i.e. fire) posted in a conspicuous location
~ Reputation
~ Regulatory compliance
~ All staff certified in CPR and First Aid
~ Reputation
~ Regulatory compliance
~ Staffing Plan
~ Regulatory compliance (staff to client ratio)
~ Continuity of care
~ Clear description of admission criteria for each program including diagnosis, age, disqualifying issues (medical, criminal)
~ Safe environment of care for current clients
~ Defense against discrimination suits
Policies and Risks
~ Appropriate intake processes
~ Ensure a safe and supportive environment of care
~ Provides referrals as needed to ensure client stabilization
~ Client data is stored in compliance with HIPAA and HITECH regulations
~ Continuity of care
~ Regulatory compliance
~ Reputation
~ Orientation process for new clients
~ Communicates rights and responsibilities to ensure a safe environment
Policies and Risks
~ Handling missed appointments
~ Client destabilization/suicidality
~ Client dissatisfaction/reputation
~ Termination due to client drop out
~ Prevent complaint of abandonment
~ Prevent liability for suicide
~ Ensuring medication compliance
~ Ensure client stabilization
~ An unclean environment can be considered breach of duty if a patient contracts an illness—more applicable to group homes, residential and hospitals
~ Personal injury liability
~ Reputation of the agency and the Field
Policies and Risks
~ Agency should have a disaster response policy to maintain continuity of care in the event of a data failure or physical disaster (flood, sink hole, tornado)
~ How to access data at the remote location
~ Where clients are to go to receive treatment in the event of a physical disaster / displacement
~ Policy to address handling clients or potential clients in crisis if the therapist is out sick.
~ Policy to refer clients if the agency or a program therein should shut down
Did you know…
~ Health and safety inspections should include refrigerator temperature monitoring every week
~ A MSDS book should be on the premises and include data on all hazardous chemicals stored there.
~ Facilities are required by HIPAA to store data backups in a secure location in the event of local data failure
~ Many states have regulatory limits on client to staff ratios and guidelines for the number of sq. ft per client.
~ Level of Care Guidelines inform the agency what services must be provided to prevent possible paybacks and termination of provider contracts
~ To be effective, risk analysis surveys must be completed regularly and updated as the organization changes (i.e. addition of a new program)
More things to be aware of…
~ Employees should complete a training on emergency procedures (fire, flood, power outage, severe weather etc.) annually
~ It is a good idea to consider having a policy which clients sign regarding suspected drunk driving and/or attending treatment under the influence
~ Social networking and internet data (client or employee) has been used in legal cases and can significantly damage a company’s reputation…
~ Facebook
~ Instagram
~ Yelp
~ Google places
~ Health grades
~ InTheRooms.org
Summary
~ Risk Management involves not only professional and ethical risk, but also managing the risks at your facility.
~ Risks can come in the form of:
~ Causing harm (directly or indirectly—Law suits, reputation)
~ Breaking the law (criminal and or civil fines and punishments; reputation)
~ Violating regulatory codes (Temp/permanent shut down)
~ Failure to plan/adapt to funding changes (Loss of cash flow)
~ Effective risk management occurs regularly (at least annually) and is updated with agency changes or addition of new programs
~ Effective risk management reduces monies required for non-mission oriented purposes, manages reputation and prevents financial catastrophe.